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:RN1201injection for Relapsed/Refractory CD19+/BCMA+ Hematologic Malignancies
⚠ 该试验的登记信息已有 14 个月未更新, 页面上显示的「尚未开始招募」可能已经失效。联系研究中心之前,建议先到 ClinicalTrials.gov 核对登记原文的最新状态与联系方式。
这是一项 I 期注册临床试验,评估异体 CAR-T 细胞治疗血液系统恶性肿瘤、急性淋巴细胞白血病、多发性骨髓瘤的安全性、可行性及初步疗效。当前状态:尚未开始招募。计划入组 27 例。试验地点:中国 · 南京(共 1 个中心,其中中国 1 个)。登记号:NCT07113496。
不限性别 · ≥ 18 Years
纳入标准: 1. 自愿参加并签署知情同意书。 2. 根据WHO 2017年分类,病理确诊为CD19阳性和/或B细胞成熟抗原(BCMA)阳性血液系统恶性肿瘤,包括但不限于多发性骨髓瘤、B细胞急性淋巴细胞白血病(B-ALL)、成熟B细胞淋巴瘤和浆母细胞淋巴瘤。 3. 复发/难治性疾病:标准治疗后未达到完全缓解,或初始应答后在治疗期间或随访期间复发。 4. 需有可测量疾病: (1)B-ALL:血液学缓解后仍持续MRD阳性。 (2)淋巴瘤:根据修订版国际工作组(IWG)标准至少有1个最长径≥1.5 cm的可测量病灶。 (3)多发性骨髓瘤:免疫固定电泳阳性或存在髓外病变。 5. 年龄≥18岁,男女均可。 6. 预期生存期≥12周。 7. 器官功能充足(疾病相关功能受损者可由研究者酌情判断): (1)总胆红素<正常值上限(ULN)的2倍;血清肌酐<ULN;ALT和AST<ULN的3倍。 (2)中性粒细胞绝对计数≥0.5×10⁹/L;血小板≥20×10⁹/L(有骨髓受累证据者无此要求)。 (3)ECOG体能状态评分0~3分。 (4)左心室射血分数(LVEF)≥50%。 排除标准: 1. 已知对CD19/BCMA-UCAR-T或任何研究药物(氟达拉滨、环磷酰胺、托珠单抗)过敏、不耐受或存在禁忌证。 2. 患有Fanconi贫血、Kostmann综合征、Shwachman综合征或任何已确诊的骨髓衰竭综合征。 3. 存在需要静脉抗生素治疗的活动性或未控制感染,或有严重活动性感染证据。 4. NYHA Ⅲ或Ⅳ级心力衰竭(明确由基础恶性肿瘤导致者除外)。 5. 存在与原发血液系统恶性肿瘤无关的中枢神经系统(CNS)疾病。 6. 既往患有恶性肿瘤;经充分治疗的皮肤、宫颈、肺原位癌或其他非活动性肿瘤除外。 7. 存在显著出血倾向(如胃肠道出血、凝血障碍、脾功能亢进)。 8. 过去3个月内有显著心脏病史,且研究者判断患者无法耐受参加研究。 9. 妊娠、哺乳或计划在6个月内妊娠。 10. 研究者认为可能增加风险或干扰研究结果的任何情况。
Inclusion Criteria 1. Voluntary participation with signed informed consent. 2. Pathologically confirmed CD19-positive and/or B-cell maturation antigen (BCMA)-positive hematologic malignancy according to the WHO 2017 classification, including but not limited to multiple myeloma, B-cell acute lymphoblastic leukemia (B-ALL), mature B-cell lymphomas, and plasmablastic lymphoma. 3. Relapsed/refractory disease defined as failure to achieve complete remission after standard therapy, or relapse after an initial response during treatment or follow-up. 4. Measurable disease required: 1. For B-ALL: persistent minimal residual disease (MRD) positivity despite hematologic remission. 2. For lymphoma: at least one measurable lesion ≥1.5 cm in longest diameter per IWG revised criteria. 3. For multiple myeloma: positive immunofixation electrophoresis or presence of extramedullary disease. 5. Age ≥18 years; both sexes eligible. 6. Expected survival ≥12 weeks. 7. Adequate organ function (exceptions for disease-related impairment are at the investigator's discretion): 1. Total bilirubin \<2× upper limit of normal (ULN); serum creatinine \<ULN; ALT and AST \<3× ULN. 2. Absolute neutrophil count ≥0.5×10⁹/L; platelets ≥20×10⁹/L (no requirement if marrow involvement is documented). 3. Eastern Cooperative Oncology Group (ECOG) performance status 0-3. 4. Left ventricular ejection fraction (LVEF) ≥50%. Exclusion Criteria 1. Known hypersensitivity, allergy, intolerance, or contraindication to CD19/BCMA-UCAR-T or any study drugs (fludarabine, cyclophosphamide, tocilizumab). 2. Genetic syndromes: Fanconi, Kostmann, Shwachman, or any documented bone-marrow failure syndrome. 3. Active or uncontrolled infection requiring IV antibiotics; evidence of severe active infection. 4. NYHA Class III or IV heart failure (unless clearly secondary to the underlying malignancy). 5. Central Nervous System (CNS) disorders unrelated to the primary hematologic malignancy. 6. Prior malignancy except adequately treated carcinoma in situ of skin, cervix, lung, or other non-active tumors. 7. Significant bleeding diathesis (e.g., gastrointestinal (GI) bleeding, coagulopathy, hypersplenism). 8. History of significant cardiac disease within the past 3 months that, in the investigator's judgment, renders the patient unable to tolerate study participation.. 9. Pregnancy, lactation, or planned pregnancy within 6 months. 10. Any condition that, in the investigator's opinion, may increase risk or interfere with study results.
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:The incidence and severity of treatment-emergent adverse events (TEAEs) and dose-limiting toxicities (DLTs) · TEAEs and DLTs will be graded according to CTCAE v5.0 and ASTCT consensus criteria · DLTs: Within 28 days after CAR-T cell infusion; TEAEs: From infusion up to 12 months post-treatment.
次要终点:Objective Response Rate (ORR);Disease control rate (DCR);Progression-free survival (PFS);Overall survival (OS);Cmax of RN1201;Tmax of RN1201;Cytokines in the peripheral blood after RN1201 infusion
通过静脉输注RN1201细胞。
这项单臂、剂量递增探索性试验评估异基因CAR-T(UCAR-T)细胞治疗复发或难治性CD19阳性和/或BCMA阳性血液系统恶性肿瘤患者(包括MRD阳性患者)的安全性和疗效。符合条件的患者接受淋巴细胞清除治疗后单次输注UCAR-T细胞;根据疾病状态,输注安排在移植后或不进行移植。试验将评估总缓解率、疾病控制率、治疗期间出现的不良事件以及UCAR-T细胞在体内的行为。
This single-arm, dose-escalation exploratory trial evaluates the safety and efficacy of Allogeneic CAR-T (UCAR-T) cell therapy in patients with relapsed or refractory CD19+/BCMA+ hematologic malignancies, including those with minimal residual disease (MRD). Eligible patients will receive lymphodepletion followed by a single infusion of UCAR-T cells, either post-transplant or without transplantation depending on disease status. The trial assesses overall response and disease control rates, treatment-emergent adverse events, and in vivo behavior of UCAR-T cells.
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