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 of Anti-CD19/BCMA Universal CAR-T Cell Therapy RD06-05 in Patients With Autoimmune Diseases.
这是一项早期 I 期注册临床试验,评估 T 细胞治疗胶质母细胞瘤的安全性、可行性及初步疗效。当前状态:招募中。计划入组 96 例。试验地点:中国 · 上海(共 1 个中心,其中中国 1 个)。登记号:NCT07203404。
不限性别 · ≥ 18 Years 且 ≤ 75 Years
纳入标准: 1. 愿意且能够提供书面知情同意。 2. 年龄≥18岁且≤75岁。 3. 器官功能良好,定义如下: 1. 骨髓功能:定义为绝对中性粒细胞计数(ANC)≥1500/μL,绝对淋巴细胞计数(ALC)≥100/μL,血红蛋白(Hb)≥80 g/L,血小板计数(PLT)≥50,000/μL。为满足这些标准,筛选前7天内不得使用输血和生长因子。 2. 肝功能:定义为丙氨酸氨基转移酶(ALT)和天冬氨酸氨基转移酶(AST)≤3×正常上限(ULN),总胆红素<1.5×ULN(Gilbert综合征受试者<3.0×ULN)。 3. 凝血功能:定义为国际标准化比值(INR)或部分凝血活酶时间(PTT)≤1.5×ULN。 4. 肺功能:定义为根据CTCAE呼吸困难≤1级,且室内空气下血氧饱和度(SpO₂)≥92%(通过脉搏血氧测定法)。 4. 有生育能力的女性受试者必须血清或尿液妊娠试验阴性。手术绝育或绝经至少2年的女性被认为无生育能力。 5. 从签署知情同意书之时起至RD06-05输注完成后6个月,有生育能力的女性受试者和其伴侣有生育能力的男性受试者必须使用高效避孕方法。 抗GBM病受试者的纳入标准: 根据2012年Chapel Hill共识会议定义诊断为抗GBM病,需同时满足以下两项标准: 1. 抗GBM抗体阳性(基于历史或筛选检测结果); 2. 筛选时有肾脏受累证据,定义为: 1. 存在活动性、病理学证实的抗GBM病(肾活检必须在筛选访视前1年内或筛选期间进行);且 2. 伴有蛋白尿和血尿。 SLE/LN受试者的纳入标准: 1. 根据2019年欧洲抗风湿病联盟(EULAR)/美国风湿病学会(ACR)分类标准或2012年系统性红斑狼疮国际协作组(SLICC)分类标准诊断为SLE。 2. 筛选时抗核抗体(ANA)和/或抗双链DNA(anti-dsDNA)抗体和/或抗Smith(anti-Sm)抗体阳性。 3. 筛选时SLEDAI-2K评分>6分。 AAV/AAGN受试者的纳入标准: 1. 根据2022年ACR/EULAR ANCA相关性血管炎分类标准诊断为显微镜下多血管炎(MPA)或肉芽肿性多血管炎(GPA)。 2. 筛选时或基于历史检测抗髓过氧化物酶(MPO-ANCA)抗体或抗蛋白酶3(PR3-ANCA)抗体阳性。 3. 对于无肾脏受累的AAV:筛选时伯明翰血管炎活动评分(BVAS)第3版评分≥3分,表明活动性血管炎。 MN受试者的纳入标准: 1. 经肾活检病理确诊为原发性(特发性)膜性肾病(肾活检须在筛选前2年内或筛选期间进行)。 2. 符合高危或难治/复发性膜性肾病的标准: 高危患者,定义为符合以下任一标准: 1. eGFR正常且24小时尿蛋白>3.5g,经ACEI/ARB治疗6个月后尿蛋白下降<50%,且血清白蛋白<25 g/L或抗PLA2R抗体>50 RU/mL; 2. eGFR <60 mL/min/1.73m²和/或24小时尿蛋白>8g持续超过6个月。 难治/复发性患者: 难治性患者定义为对既往免疫抑制治疗耐药者(持续性24小时尿蛋白≥3.5g,较基线下降<50%)。 复发性患者定义为既往经免疫抑制治疗达到完全或部分缓解,但随后出现复发性24小时尿蛋白≥3.5g者。 SSC受试者的纳入标准: 1. 根据2013年美国风湿病学会(ACR)/欧洲抗风湿病联盟(EULAR)分类标准诊断为系统性硬化症(SSc)。 2. 筛选时诊断为弥漫性皮肤型SSc。 IIM受试者的纳入标准: 1.根据2017年ACR/EULAR分类标准诊断为特发性炎性肌病(IIM)(包括可能或明确诊断,对应概率评分≥55%)。亚型包括皮肌炎(DM)、抗合成酶综合征(ASS)和免疫介导坏死性肌病(IMNM)。 IgAN受试者的纳入标准: 1. 经筛选前2年内获得的肾活检病理结果确诊为原发性IgA肾病。 2. 筛选时,24小时尿蛋白≥1 g/24 h,或尿蛋白与肌酐比值(UPCR)≥0.75 g/g。 3. 筛选时,估算肾小球滤过率(eGFR)≥30 mL/min/1.73 m²。 4. 筛选前必须已完成至少3个月的标准治疗,且药物剂量稳定维持至少4周;标准治疗药物包括ACEI、ARB和/或SGLT2抑制剂。 5. 筛选时,受试者血压应控制在≤150/90 mmHg。 排除标准: 1. SLE/LN受试者: 1. 筛选期间经合格专科医生评估,存在严重活动性中枢神经系统(CNS)狼疮,包括精神病、癫痫发作、狼疮性头痛或其他与神经精神性狼疮相关的体征/症状。 2. 药物诱导性或继发性狼疮。 2. AAV/AAGN受试者: 1. 药物诱导性或继发性AAV/AAGN。 2. 筛选时存在需要侵入性通气支持的肺泡出血。 3. 抗GBM病受试者: 1. 无尿超过7天。 2. 依赖透析超过30天。 3. 持续中度或重度肺出血(或过去两周内停止),定义为需要辅助通气、补充氧气或输血的肺出血。 4. 症状性充血性心力衰竭(NYHA 2-4级),需要处方药物治疗或具有临床意义的心源性外周水肿。 4. 患有MN的受试者: 继发性膜性肾病。 5. 患有IIM的受试者: 筛选时存在严重横纹肌溶解或CK水平≥120 × ULN。 6. 患有SSc的受试者: 1. 筛选前1年内有硬皮病肾危象病史。 2. 筛选前6个月内有心脏压塞病史。 3. 筛选前3个月内有指端溃疡活动性感染。 4. 筛选时存在指端坏疽。 7. 患有IgAN的受试者: 1. 由过敏性紫癜、系统性红斑狼疮、肝炎、感染或其他情况诱发的继发性IgA肾病患者。 2. 同时诊断为其他病因的慢性肾脏病,包括但不限于糖尿病肾病或其他原发性肾小球病,若研究者判断此类情况可能增加风险或混淆疗效评估,则将排除。 3. 肾活检病理显示肾小管萎缩或间质纤维化≥75%;或全球性肾小球硬化累及≥75%的肾小球。
Inclusion Criteria: 1. Willing and able to provide written informed consent. 2. Aged ≥18 years and ≤75 years. 3. Adequate organ function defined as: 1. Bone marrow function: Defined as absolute neutrophil count (ANC) ≥1500/μL, absolute lymphocyte count (ALC) ≥100/μL, hemoglobin (Hb) ≥80 g/L, and platelet count (PLT) ≥50,000/μL. Transfusions and growth factors must not have been used within 7 days prior to screening to meet these criteria. 2. Liver function: Defined as alanine aminotransferase (ALT) and aspartate aminotransferase (AST) ≤3 × upper limit of normal (ULN), and total bilirubin \<1.5 × ULN (or \<3.0 × ULN for subjects with Gilbert's syndrome). 3. Coagulation function: Defined as international normalized ratio (INR) or partial thromboplastin time (PTT) ≤1.5 × ULN. 4. Pulmonary function: Defined as dyspnea ≤ Grade 1 per CTCAE and oxygen saturation (SpO₂) ≥92% on room air (by pulse oximetry). 4. Female subjects of childbearing potential must have a negative serum or urine pregnancy test. Females who are surgically sterile or postmenopausal for at least 2 years are considered not of childbearing potential. 5. From the time of signing the informed consent form until 6 months after the completion of RD06-05 infusion, female subjects of childbearing potential and male subjects with partners of childbearing potential must use highly effective methods of contraception. Inclusion Criteria for Subjects with Anti-GBM Disease: Diagnosis of anti-GBM disease according to the 2012 Chapel Hill Consensus Conference definitions, meeting both of the following criteria: 1. Positive for anti-GBM antibody (based on historical or screening test results); 2. Evidence of renal involvement at screening, defined as: 1. Presence of active, pathologically confirmed anti-GBM disease (renal biopsy must have been performed within 1 year prior to the screening visit or during the screening period); and 2. Accompanied by proteinuria and hematuria. Inclusion Criteria for Subjects with SLE/LN: 1. Diagnosis of SLE according to the 2019 European Alliance of Associations for Rheumatology (EULAR)/American College of Rheumatology (ACR) classification criteria or the 2012 Systemic Lupus International Collaborating Clinics (SLICC) classification criteria. 2. Positive for antinuclear antibody (ANA), and/or anti-double-stranded DNA (anti-dsDNA) antibody, and/or anti-Smith (anti-Sm) antibody at screening. 3. SLEDAI-2K score \> 6 points at screening. Inclusion Criteria for Subjects with AAV/AAGN: 1. Diagnosis of microscopic polyangiitis (MPA) or granulomatosis with polyangiitis (GPA) according to the 2022 ACR/EULAR classification criteria for ANCA-associated vasculitis. 2. Positive for anti-myeloperoxidase (MPO-ANCA) antibody or anti-proteinase 3 (PR3-ANCA) antibody at screening or based on historical testing. 3. For AAV without renal involvement: A Birmingham Vasculitis Activity Score (BVAS) version 3 score of ≥3 at screening, indicating active vasculitis. Inclusion Criteria for Subjects with MN: 1. Diagnosis of primary (idiopathic) membranous nephropathy confirmed by renal biopsy pathology (the renal biopsy must have been performed within 2 years prior to screening or during the screening period). 2. Meeting the criteria for high-risk or relapsed/refractory membranous nephropathy: High-risk patients, defined as meeting any of the following criteria: 1. Normal eGFR with urine protein \>3.5g/24h, a reduction of \<50% in urine protein after 6 months of ACEI/ARB treatment, and serum albumin \<25 g/L or anti-PLA2R antibody \>50 RU/mL; 2. eGFR \<60 mL/min/1.73m² and/or urine protein \>8g/24h for more than 6 months. Refractory/Relapsed patients: Refractory patients are defined as those resistant to prior immunosuppressive therapy (persistent urine protein ≥3.5g/24h with a \<50% reduction from baseline). Relapsed patients are defined as those who achieved complete or partial remission with prior immunosuppressive therapy but subsequently developed recurrent urine protein ≥3.5g/24h. Inclusion Criteria for Subjects with SSC: 1. Diagnosis of systemic sclerosis (SSc) according to the 2013 American College of Rheumatology (ACR)/European Alliance of Associations for Rheumatology (EULAR) classification criteria. 2. Diagnosis of diffuse cutaneous SSc at screening. Inclusion Criteria for Subjects with IIM: 1.Diagnosis of idiopathic inflammatory myopathy (IIM) according to the 2017 ACR/EULAR classification criteria (including probable or definite diagnosis, corresponding to a probability score of ≥55%). The subtypes include dermatomyositis (DM), anti-synthetase syndrome (ASS), and immune-mediated necrotizing myopathy (IMNM). Inclusion Criteria for Subjects with IgAN: 1. Definitive diagnosis of primary IgA nephropathy confirmed by renal biopsy pathology results obtained within 2 years prior to screening. 2. At screening, 24-hour urinary protein ≥1 g/24 h, or urine protein-to-creatinine ratio (UPCR) ≥0.75 g/g. 3. At screening, estimated glomerular filtration rate (eGFR) ≥30 mL/min/1.73 m². 4. Standard therapy must have been completed for a minimum of 3 months before screening, with a stable drug dose maintained for at least 4 weeks; standard therapeutic agents include ACEIs, ARBs, and/or SGLT2 inhibitors. 5. At screening, the subject's blood pressure shall be controlled at ≤150/90 mmHg. Exclusion Criteria: 1. Subjects with SLE/LN: 1. Severe active central nervous system (CNS) lupus, including psychosis, seizures, lupus headache, or other signs/symptoms associated with neuropsychiatric lupus, as assessed by a qualified specialist during screening. 2. Drug-induced or secondary lupus. 2. Subjects with AAV/AAGN: 1. Drug-induced or secondary AAV/AAGN. 2. Presence of alveolar hemorrhage requiring invasive ventilatory support at screening. 3. Subjects with Anti-GBM Disease: 1. Anuria for more than 7 days. 2. Dialysis dependence for more than 30 days. 3. Ongoing moderate or severe pulmonary hemorrhage (or cessation within the past two weeks) defined as pulmonary hemorrhage requiring assisted ventilation, supplemental oxygen, or blood transfusion. 4. Symptomatic congestive heart failure (NYHA Class 2-4) requiring prescription medication or clinically significant cardiogenic peripheral edema. 4. Subjects with MN: Secondary membranous nephropathy. 5. Subjects with IIM: Presence of severe rhabdomyolysis or CK level ≥120 × ULN at screening. 6. Subjects with SSc: 1. History of scleroderma renal crisis within 1 year prior to screening. 2. History of cardiac tamponade within 6 months prior to screening. 3. Active infection of digital ulcers within 3 months prior to screening. 4. Presence of digital gangrene at screening. 7. Subjects with IgAN: 1. Patients with secondary IgA nephropathy induced by Henoch-Schönlein purpura, systemic lupus erythematosus, hepatitis, infection, or other conditions. 2. Subjects concurrently diagnosed with other etiologies of chronic kidney disease, including but not limited to diabetic nephropathy or other primary glomerulopathies, if the Investigator judges such conditions may increase risks or confound efficacy assessment, will be excluded. 3. Renal biopsy pathology showing renal tubular atrophy or interstitial fibrosis ≥75%; or global glomerulosclerosis involving ≥75% of glomeruli.
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 of adverse events (TEAEs), serious adverse events (SAEs), and adverse events of particular concern (AESI) during treatment · 2 Years
一项探索性、单臂、开放标签、剂量递增研究,评估抗CD19/BCMA通用型CAR-T疗法RD06-05在自身免疫性疾病(包括SLE/LN、AAV/AAGN、抗GBM、MN、SSc和IIM)中的安全性、耐受性、PK、PD和疗效。
An Exploratory, Single-Arm, Open-Label, Dose-Escalation Study of the Safety, Tolerability, PK, PD, and Efficacy of Anti-CD19/BCMA Universal CAR-T Therapy RD06-05 in Autoimmune Diseases (including SLE/LN, AAV/AAGN, Anti-GBM, MN, SSc, and IIM).
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