决定异体 CAR T 细胞排斥与扩增的细胞和分子机制
Cellular and molecular mechanisms determining allogeneic CAR T cell rejection and expansion.
我们评估了11例接受单一批次cemacabtagene ansegedleucel(cema-cel)治疗的大B细胞淋巴瘤患者,cemacabtagene ansegedleucel是一种异体抗CD19 CAR T产品。
英文原题:A Study to Investigate the Safety and Preliminary Efficacy of ALLO-329, an Allogeneic CAR T-cell Therapy, in Adults With Autoimmune Disease
这是一项 I 期注册临床试验,评估细胞治疗用于系统性红斑狼疮、多发性骨髓瘤、系统性硬化症的安全性、可行性及初步疗效。当前状态:招募中。计划入组 66 例。试验地点:美国 · 凤凰城、洛马林达、奥罗拉、杰克逊维尔(共 17 个中心)。登记号:NCT07085104。
不限性别 · ≥ 18 Years 且 ≤ 74 Years
纳入标准: 1. 年龄≥18岁且<75岁。 2. 造血功能以及肝、心脏和肺功能充分。 3. 筛选时,有生育能力女性的高灵敏度尿妊娠试验或血清妊娠试验结果为阴性。所有有生育能力的受试者须愿意自淋巴清除(LD)化疗或ALLO-329给药(以较晚者为准)后至少12个月(女性)或6个月(男性)采用高效避孕方法。 4. 已签署并注明日期的知情同意书。 5. 愿意且能够遵守预定访视、治疗计划、实验室检查及其他研究程序。 6. 根据相应疾病的分类标准、临床证据和/或实验室检查,确诊为活动性疾病(系统性红斑狼疮[SLE]、特发性炎性肌病[IIM]或系统性硬化症[SSc])。 7. 既往接受标准治疗(包括至少一种免疫抑制剂)至少3个月后,疾病仍有上述活动性。 排除标准: 1. 存在需要全身治疗的活动性细菌、真菌或病毒感染,或具有临床意义的活动性、机会性、慢性或复发性感染。 2. 入组前5年内存在任何活动性恶性肿瘤;但已充分治疗的局限性皮肤基底细胞癌或鳞状细胞癌、原位癌,或正在观察随访的低风险前列腺癌(Gleason评分≤6)除外。既往接受过以治愈为目的的癌症治疗,且主治肿瘤科医生认为未来10年复发概率低于10%的,经与申办方讨论后可允许入组。 3. 既往接受过靶向CD19或CD70的治疗,或任何既往工程化细胞治疗(如CAR-T疗法);本研究中既往接受ALLO-329治疗者除外。 4. 存在具有临床意义、不稳定或未控制的急性或慢性疾病(如甲状腺功能减退和糖尿病)。 5. 筛选前6个月内有需要医疗干预的有症状心脏或血管疾病;有血流动力学症状的心包积液;或存在需要医疗干预的有症状心电图异常。 6. Child-Pugh B级或C级肝硬化。 7. 有需要医疗干预的症状性气道疾病、≥2级胸腔积液,或ALLO-329给药前6个月内有需要抗凝治疗的肺栓塞病史。 8. 已知对血小板或红细胞输注无反应,或拒绝在治疗后为处理血细胞计数异常而接受有指征的输血支持。 9. 任何类型的原发性或遗传性免疫缺陷。 10. 不愿参加延长安全性监测期。 11. SLE受试者:过去6个月内有中枢神经系统受累病史或活动性中枢神经系统疾病,或药物诱发的SLE。狼疮性肾炎患者:签署知情同意书前12个月内曾接受透析、预计给药后12个月内需要肾脏替代治疗,或以下任一指标的美国国立卫生研究院(NIH)慢性化评分≥3:肾小球硬化、肾小球纤维性新月体、肾小管萎缩和/或间质纤维化。 12. IIM受试者:肌炎不属于排除标准规定的分类、存在不可逆或与IIM无关且无法评估的无力,或皮肌炎抗TIF1γ抗体阳性。 13. SSc受试者:需要治疗的肺动脉高压、快速进展或严重的SSc胃肠道受累,或既往发生硬皮病肾危象。
Inclusion Criteria: 1. Adults ≥ 18 to \< 75 years of age. 2. Adequate hematological function and liver, cardiac, and pulmonary function. 3. A highly sensitive urine pregnancy test or serum pregnancy test (for females of childbearing potential) negative at screening. All participants of childbearing potential must be willing to use a highly effective method of contraception for at least 12 months for females (6 months for males) after LD chemotherapy or ALLO-329 administration, whichever is later. 4. Signed and dated informed consent form. 5. Willing and able to comply with scheduled visits, treatment plan, laboratory tests, and other procedures. 6. Confirmed active disease (SLE, IIM, or SSc) as defined by the appropriate classification criteria for each respective disease, clinical evidence, and/or laboratory testing. 7. Disease activity as above despite prior treatment with standard of care therapy including at least one immunosuppressive agent for at least 3 months. Exclusion Criteria: 1. Participants with active systemic bacterial, fungal, or viral infection requiring systemic treatment or a clinically significant active, opportunistic, chronic or recurrent infection. 2. Any active malignancy within 5 years prior to enrollment, except for adequately treated localized basal cell or squamous cell skin cancer, carcinoma in situ or low risk prostate cancer (Gleason score ≤ 6) under observation. Prior treatment of cancer with curative intent which in the opinion of the treating oncologist has less than a 10% chance of recurrence in the next 10 years can be allowed after discussion with the sponsor. 3. Prior treatment with CD19 or CD70 targeted therapy or any prior engineered cell therapy (e.g., CAR T therapy), except prior treatment with ALLO-329 in this study. 4. Clinically significant or unstable or uncontrolled acute or chronic disease (e.g., hypothyroidism and diabetes). 5. Symptomatic cardiac or vascular disease requiring medical intervention within 6 months prior to screening, hemodynamically symptomatic pericardial effusion, or symptomatic electrocardiogram abnormality requiring medical intervention. 6. Child-Pugh Class B or C cirrhosis. 7. Symptomatic airway disease requiring medical intervention, pleural effusion ≥ Grade 2, or history of pulmonary embolism requiring anticoagulant therapy within 6 months of ALLO-329 dosing. 8. Participants known to be refractory to platelet or red blood cell transfusions or who will refuse indicated transfusion support to manage cell counts following treatment. 9. Any form of primary, inherited immunodeficiency. 10. Unwilling to participate in an extended safety monitoring period. 11. For participants with SLE: History or active disease involving CNS within the last 6 months or SLE that is drug-induced. For those with lupus nephritis, history of dialysis within 12 months prior to signing the informed consent form or expected need for renal replacement therapy within the next 12 months after dosing, or National Institutes of Health (NIH) chronicity score of 3+ in any of the following domains: glomerular sclerosis, glomerular fibrous crescents, tubular atrophy, and/or interstitial fibrosis. 12. Participants with IIM: A myositis other than specified classification per exclusion criteria, non-reversible, unrelated or weakness not amenable to assessment, or dermatomyositis with presence of anti-TIF1 gamma antibody. 13. Participants with SSc: Pulmonary arterial hypertension requiring treatment, rapidly progressive or severe SSc gastrointestinal involvement, or prior scleroderma renal crisis.
以上为辅助阅读译文。是否适合入组须由主治医生判断,最终以登记平台与研究者确认为准。
主要终点:Incidence of Dose Limiting toxicities (DLTs) and Other Safety Parameters · The incidence of dose limiting toxicities (DLTs) and other safety parameters (including but not limited to treatment emergent adverse events \[AEs\], serious adverse events \[SAEs\], and clinical laboratory abnormalities) · Up to 60 months
次要终点:Disease Response to Treatment - Systemic Lupus Erythematosus;Disease Response to Treatment - Systemic Lupus Erythematosus;Disease Response to Treatment - Lupus Nephritis;Disease Response to Treatment - Idiopathic Inflammatory Myopathy;Disease Response to Treatment - Systemic Sclerosis;Disease Response to Treatment - Systemic Sclerosis;ALLO-329 Peak Expansion (Cmax);ALLO-329 Persistence Over Time Including Area Under the Expansion Curve (AUC)
受试者先接受以环磷酰胺为基础的淋巴清除方案,随后接受ALLO-329。
受试者不接受淋巴清除方案,直接接受ALLO-329。
受试者先接受由环磷酰胺和氟达拉滨组成的淋巴清除方案,随后接受ALLO-329。
这是一项首次人体、单臂、开放标签研究,评估ALLO-329用于成人自身免疫性疾病患者时的安全性、耐受性和初步疗效。研究疾病包括伴或不伴肾脏受累的系统性红斑狼疮(SLE)、特发性炎性肌病(IIM)和系统性硬化症(SSc)。本试验旨在评估ALLO-329(一种靶向CD19和CD70的异基因双靶点嵌合抗原受体T细胞疗法)在成人自身免疫性疾病患者中的安全性和耐受性,初步观察其生物学活性和临床应答,并确定推荐的II期治疗方案(RP2R)。
This is a first-in-human, single-arm, open-label study evaluating the safety, tolerability, and preliminary efficacy of ALLO-329 in adults with autoimmune diseases: systemic lupus erythematosus (SLE) with and without renal involvement, idiopathic inflammatory myopathy (IIM), and systemic sclerosis (SSc).The purpose of this trial is to evaluate the safety and tolerability of ALLO-329, an allogeneic anti-CD19, anti-CD70 dual chimeric antigen receptor (CAR) T cell therapy, in adults with autoimmune disorders, provide initial evidence of biological activity and clinical response to the treatment and determine the recommended Phase 2 regimen (RP2R).
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