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:CD123+CLL-1 CAR-T Sequential Infusion With CD7 CAR-T and Bridging to Allo-HSCT for Relapsed/Refractory Acute Myeloid Leukemia
这是一项早期 I 期注册临床试验,评估异体 CAR-T 细胞治疗急性髓系白血病的安全性、可行性及初步疗效。当前状态:尚未开始招募。计划入组 10 例。登记号:NCT07201727。
不限性别 · ≥ 18 Years 且 ≤ 75 Years
纳入标准: 患者必须满足以下所有标准: * 临床诊断为复发或难治性急性髓系白血病; * 经流式细胞术(FCM)或免疫组织化学确认肿瘤细胞为CD123或CLL-1阳性,阳性率不低于80%; * 年龄18至75岁(含); * 自签署知情同意书之日起预期生存时间超过3个月; * KPS≥80分; * 重要器官功能需满足以下条件:①LVEF>50%,且心电图正常;②血氧饱和度≥90%;③SCr≤2.5ULN;④ALT和AST≤5ULN,TBil≤3ULN; * 有生育意愿的受试者必须同意在研究入组前及研究结束后六个月内采取避孕措施。如发生妊娠或疑似妊娠,应及时通知研究者。 * 受试者或监护人理解并签署知情同意书(ICF)。 排除标准: 符合以下任何一条者将不符合本研究的入组条件: * 签署知情同意书前一年内,有纽约心脏病协会(NYHA)分级≥III级的心力衰竭病史,或心肌梗死、心脏血管成形术或支架植入术、不稳定型心绞痛,或其他临床症状明显的心脏疾病,或筛选期间QTc间期>480 ms(QTc间期按Fridericia公式计算); * 患有活动性GvHD或需要使用免疫抑制剂者; * 过去5年内患有除急性髓系白血病(AML)以外的任何恶性肿瘤的患者,但已充分治疗的宫颈原位癌、皮肤基底细胞癌或鳞状细胞癌、局部切除的前列腺癌或切除的乳腺导管原位癌除外; * 筛选前7天内有需要全身治疗的活动性感染或无法控制的感染的患者,但轻度泌尿生殖道感染和上呼吸道感染除外; * 过去两年内有需要全身免疫抑制/全身疾病调节药物治疗的自身免疫性疾病病史(如类风湿关节炎、系统性红斑狼疮、克罗恩病); * 筛选时,若乙型肝炎表面抗原(HBsAg)或乙型肝炎核心抗体(HbcAb)阳性且外周血乙型肝炎病毒(HBV)DNA高于检测下限,需排除。若丙型肝炎病毒(HCV)抗体阳性,外周血HCV RNA阳性者需排除。人类免疫缺陷病毒(HIV)抗体阳性者;巨细胞病毒(CMV)DNA检测阳性者;嗜淋巴细胞人疱疹病毒(EBV)DNA检测阳性者;梅毒螺旋体特异性抗体(TPPA)检测阳性者需排除; * 在4周内或距前次临床试验末次给药5个半衰期内(以较长者为准)参加过其他临床试验; * 有生物制品严重过敏史; * 研究者判断的不稳定系统性疾疾:包括但不限于需要医疗治疗的严重肝、肾或代谢性疾病; * 妊娠或哺乳期妇女,计划在CAR-T细胞输注后2年内怀孕的女性受试者,或其伴侣计划在其CAR-T细胞输注后2年内怀孕的男性受试者; * 研究者认为可能增加受试者风险或干扰试验结果的情况。
Inclusion Criteria: Patients must meet all of the following criteria: * Patients are clinically diagnosed with relapsed or refractory acute myeloid leukemia; * Tumor cells are confirmed to be CD123 or CLL-1 positive by flow cytometry (FCM) or immunohistochemistry, with a positivity rate of no less than 80%; * Patients aged 18 to 75 years (inclusive); * The expected survival time is more than 3 months from the date of signing the informed consent; * KPS≥80 points; * The functions of vital organs need to meet the following conditions: ①LVEF\>50%,and electrocardiogram is normal; ② Oxygen saturation ≥90%;③ SCr≤2.5ULN;④ALT and AST≤5ULN,TBil≤3ULN; * Subjects intending to conceive must agree to use contraception prior to study enrollment and for six months post-study. In the event of pregnancy or suspected pregnancy, they should promptly notify the investigator. * The subject or guardian understands and signs the Informed Consent Form (ICF). Exclusion Criteria: Any of the following conditions will not be eligible for enrolment in this study: * Within one - year prior to signing the informed consent form, there is a history of heart failure of New York Heart Association (NYHA) class ≥ III, or myocardial infarction, cardiac angioplasty or stent implantation, unstable angina pectoris, or other cardiac diseases with prominent clinical symptoms, or the QTc interval is \> 480 ms during screening (the QTc interval is calculated by the Fridericia formula); * Those with active GvHD or those who need to use immunosuppressants; * Patients who have had any malignancy other than acute myeloid leukemia (AML) within the past 5 years, except for those with adequately treated cervical carcinoma in situ, basal cell or squamous cell carcinoma of the skin, locally resected prostate cancer, or resected ductal carcinoma in situ of the breast; * Patients who have active infections requiring systemic treatment or uncontrollable infections within 7 days prior to screening, except for mild urinary and genital infections and upper respiratory infections; * There has been a history of autoimmune diseases (such as rheumatoid arthritis, systemic lupus erythematosus, Crohn's disease) that require systemic immunosuppressive/systemic disease regulatory drugs for treatment within the past two years; * When screening, if the hepatitis B surface antigen (HBsAg) or hepatitis B core antibody (HbcAb) is positive and the peripheral blood hepatitis B virus (HBV) DNA is higher than the detection limit, it needs to be excluded. If the hepatitis C virus (HCV) antibody is positive, those with positive HCV RNA in peripheral blood need to be excluded. Those who are positive for human immunodeficiency virus (HIV) antibodies; Those who test positive for cytomegalovirus (CMV) DNA; Those with positive DNA test for lymphotropic human herpesvirus (EBV); Those who test positive for Treponema pallidum specific antibody (TPPA) need to be excluded; * Participation in another clinical trial within 4 weeks or within 5 half-lives of the last dose of the drug from the previous clinical trial (whichever is longer); * Has a history of severe allergy to biological products; * Unstable systemic diseases as judged by the investigator: including but not limited to severe liver, kidney or metabolic diseases requiring medical treatment; * Pregnant or lactating women, female subjects who plan to become pregnant within 2 years after CAR-T cell infusion, or male subjects whose partners plan to become pregnant within 2 years after their CAR-T cell infusion; * conditions that the investigator believes may increase the risk to the subject or interfere with the results of the trial.
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:Monitor and record adverse events · From CAR - T cell infusion to 2 years later.
次要终点:Overall Response Rate
使用CD123+CLL-1双靶点CAR-T(JY017)治疗,随后对未达到MRD阴性的患者序贯输注CD7靶向CAR-T(JY008),根据患者情况行allo-HSCT。
本研究是一项单臂、开放、前瞻性临床试验,以难治复发性急性髓系白血病患者为研究对象,计划入组10例,评估序贯CD123+CLL-1 CAR-T细胞后续CD7 CAR-T细胞治疗的安全性和有效性。
This study is a single-arm, open-label, prospective clinical trial, with patients suffering from refractory and relapsed acute myeloid leukemia as the subjects. It plans to enroll 10 cases to evaluate the safety and efficacy of sequential CD123+CLL-1 CAR-T cells followed by CD7 CAR-T cells treatment.
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