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:Exploratory Study of Umbilical Cord Blood-Derived CAR-NK Cell Therapy Targeting TRBC1/2 for Relapsed/Refractory T-Cell Lymphoma
这是一项 I 期注册临床试验,评估 CAR-T 细胞治疗外周 T 细胞淋巴瘤的安全性、可行性及初步疗效。当前状态:招募中。计划入组 45 例。试验地点:中国 · 杭州(共 1 个中心,其中中国 1 个)。登记号:NCT07164560。
不限性别 · ≥ 18 Years 且 ≤ 75 Years
纳入标准 根据2016年WHO淋巴系统肿瘤分类,复发/难治性外周T细胞淋巴瘤(PTCL)患者须符合以下标准方可入组: 1. 自愿同意参加本研究并签署知情同意书。 2. 年龄18至75岁,男性或女性。 3. 诊断为复发/难治性PTCL,定义为≥1线既往治疗失败。符合条件的组织学亚型包括(但不限于): 血管免疫母细胞性T细胞淋巴瘤(AITL)间变性大细胞淋巴瘤(ALCL)外周T细胞淋巴瘤,非特指型(PTCL-NOS) 4. 预计生存期≥12周。 5. TRBC1/2阳性肿瘤组织(免疫组化≥20%)或经PCR或NGS确认的TCR基因重排。 6. ECOG体能状态评分为0-2。 7. 器官功能符合以下标准: ALT和AST ≤ 2.5 × 正常值上限(ULN)肌酐清除率(Cockcroft-Gault)≥ 60 mL/min总胆红素 ≤ 1.5 × ULN左心室射血分数(LVEF)≥ 50%基线室内空气下血氧饱和度 > 92% 血液学: Ia期:ANC > 1500/mm³,血小板 > 75 × 10⁹/L,血红蛋白 > 9 g/dL Ib期:ANC > 1000/mm³,血小板 > 50 × 10⁹/L,血红蛋白 > 8 g/dL 8. 既往自体造血干细胞移植后≥3个月。 9. 允许既往接受靶向不同抗原的CAR-NK治疗,前提是经≥3个月评估确认无效,或达到完全缓解(CR)后出现复发。 10. 有生育能力的女性在入组前妊娠试验必须为阴性。所有患者(男性和女性)必须同意在研究期间采取有效避孕措施。 11. 存在至少一个可测量病灶。 12. 所有已批准的既往抗肿瘤治疗(包括全身化疗、全身放疗或免疫治疗)必须在研究药物给药前≥3周完成;对于非化疗靶向药物,需≥2周洗脱期。 排除标准 符合以下任一标准的患者将被排除在本研究之外: 1. 对细胞产品任何成分有过敏史。 2. 有其他未达到缓解的恶性肿瘤病史。 3. 既往接受过异基因造血干细胞移植或实体器官移植。 4. 过去3个月内接受过基因治疗。 5. 未控制的全身性活动性感染(单纯性尿路感染或细菌性咽炎除外)。允许预防性使用抗生素、抗病毒或抗真菌药物。 6. 活动性乙型肝炎感染(HBsAg阳性;但HBV-DNA <10³ copies/mL的患者不被排除)、活动性丙型肝炎病毒感染(包括携带者)、梅毒或其他获得性或先天性免疫缺陷疾病,包括但不限于HIV感染。 7. 纽约心脏协会(NYHA)III级或IV级心力衰竭。 8. 既往抗肿瘤治疗导致的未缓解毒性(定义为CTCAE v5.0分级>1级,但疲劳、厌食和脱发除外)。 9. 筛选时存在中枢神经系统(CNS)受累证据,或具有临床意义的CNS疾病,如癫痫发作史或其他CNS疾病。 10. 既往暴露于任何特异性靶向TRBC1/2的药物。 11. 不愿停止哺乳的哺乳期女性。 12. 研究者认为可能增加患者风险或干扰研究结果的任何其他情况。 13. COVID-19或甲型流感病毒检测呈阳性者。
Inclusion Criteria According to the 2016 WHO classification of lymphoid neoplasms, patients with relapsed/refractory peripheral T-cell lymphoma (PTCL) must meet the following criteria to be eligible for enrollment: 1. Voluntarily agree to participate in this study and provide signed informed consent. 2. Age 18 to 75 years, male or female. 3. Diagnosis of relapsed/refractory PTCL, defined as failure of ≥1 prior line of therapy. Eligible histologic subtypes include (but are not limited to): Angioimmunoblastic T-cell lymphoma (AITL) Anaplastic large cell lymphoma (ALCL) Peripheral T-cell lymphoma, not otherwise specified (PTCL-NOS) 4. Estimated life expectancy ≥12 weeks. 5. TRBC1/2-positive tumor tissue (≥20% by immunohistochemistry) OR TCR gene rearrangement confirmed by PCR or NGS. 6. ECOG performance status of 0-2. 7. Adequate organ function as defined below: ALT and AST ≤ 2.5 × upper limit of normal (ULN) Creatinine clearance (Cockcroft-Gault) ≥ 60 mL/min Total bilirubin ≤ 1.5 × ULN Left ventricular ejection fraction (LVEF) ≥ 50% Baseline oxygen saturation \> 92% on room air Hematology: Phase Ia: ANC \> 1500/mm³, platelets \> 75 × 10⁹/L, hemoglobin \> 9 g/dL Phase Ib: ANC \> 1000/mm³, platelets \> 50 × 10⁹/L, hemoglobin \> 8 g/dL 8. ≥3 months since prior autologous hematopoietic stem cell transplantation. 9. Prior CAR-NK therapy targeting a different antigen is permitted if lack of efficacy was confirmed after ≥3 months of evaluation, or if complete remission (CR) was achieved but relapse occurred. 10. Women of childbearing potential must have a negative pregnancy test prior to enrollment. All patients (male and female) must agree to use effective contraception during the study. 11. Presence of at least one measurable lesion. 12. All approved prior anti-tumor therapies (including systemic chemotherapy, total body irradiation, or immunotherapy) must have been completed ≥3 weeks before study drug administration; for non-chemotherapy targeted agents, a washout period of ≥2 weeks is required. Exclusion Criteria Patients meeting any of the following criteria will be excluded from this study: 1. History of allergy to any component of the cell product. 2. History of another malignancy that has not achieved remission. 3. Prior allogeneic hematopoietic stem cell transplantation or solid organ transplantation. 4. Receipt of gene therapy within the past 3 months. 5. Uncontrolled systemic active infection (with the exception of simple urinary tract infection or bacterial pharyngitis). Prophylactic use of antibiotics, antivirals, or antifungal agents is permitted. 6. Active hepatitis B infection (HBsAg positive; however, patients with HBV-DNA \<10³ copies/mL are not excluded), active hepatitis C virus infection (including carriers), syphilis, or other acquired or congenital immunodeficiency diseases, including but not limited to HIV infection. 7. New York Heart Association (NYHA) Class III or IV heart failure. 8. Unresolved toxicity from prior anti-tumor therapy (defined as CTCAE v5.0 Grade \>1, with the exception of fatigue, anorexia, and alopecia). 9. Evidence of central nervous system (CNS) involvement at screening, or clinically significant CNS disease such as a history of seizures or other CNS disorders. 10. Prior exposure to any agent specifically targeting TRBC1/2. 11. Lactating women who are unwilling to discontinue breastfeeding. 12. Any other condition that, in the opinion of the investigator, may increase patient risk or interfere with the study results. 13. People who test positive for COVID-19 or influenza A virus.
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 toxicity (DLTs) · To evaluate the safety, tolerability, and determine the recommended dosage of peripheral blood-derived Anti-TRBC1/2 CAR-T Cell Therapy for refractory/relapsed peripheral T-cell lymphoma. · Up to 28 days
次要终点:Complete response rate (CR)
本研究旨在评估靶向TRBC1/2的脐带血来源CAR-NK细胞疗法(TRBC1/2 CAR-NK细胞)在难治性或复发性外周T细胞淋巴瘤(PTCL)患者中的安全性和有效性。
This study aims to evaluate the safety and efficacy of Umbilical Cord Blood-Derived CAR-NK Cell Therapy Targeting TRBC1/2 (TRBC1/2 CAR-NK cells) in patients with refractory or relapsed peripheral T-cell lymphoma (PTCL).
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