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:Safety and Efficacy of Umbilical Cord Blood-Derived Mesenchymal Stem Cells in the Treatment of Long-Term Cytopenia After CAR-T Therapy
这是一项早期 I 期注册临床试验,评估间充质干细胞治疗多发性骨髓瘤的安全性、可行性及初步疗效。当前状态:招募中。计划入组 15 例。试验地点:中国 · 天津(共 1 个中心,其中中国 1 个)。登记号:NCT07212335。
不限性别 · ≥ 18 Years
纳入标准 患者必须满足以下所有标准才能入组本研究: * 1.自愿参加研究并签署知情同意书; * 2.年龄≥18岁,性别不限; * 3.急性淋巴细胞白血病(ALL)、淋巴瘤或多发性骨髓瘤患者,在CAR-T细胞输注后3周仍存在严重血细胞减少(符合以下任一条件:中性粒细胞绝对计数≤1×10⁹/L;血小板计数≤30×10⁹/L;血红蛋白≤70 g/dL); * 4.ECOG体能状态评分≤2; * 5.预计生存时间≥6个月; * 6.育龄期女性患者需妊娠试验结果为阴性。育龄期女性患者和男性患者必须在研究期间及治疗停止后分别4个月/6个月内采取高效避孕措施。 排除标准 具有以下任一情况的患者禁止入组本研究: * 1.在CAR-T细胞输注后筛选期前1个月内接受过其他可能影响造血系统或血细胞计数的抗肿瘤治疗(包括但不限于化疗、放疗、靶向治疗、免疫治疗或造血干细胞移植); * 2.筛选期肿瘤细胞显著骨髓浸润(对于ALL:骨髓形态学检查显示白血病细胞比例>5%;对于多发性骨髓瘤(MM)和淋巴瘤:骨髓流式细胞术显示微小残留病(MRD)阳性,或骨髓病理免疫组化显示淋巴瘤/克隆性浆细胞浸润); * 3.首次给药前1周内存在以下任一情况:伴有血流动力学不稳定的感染(需要血管活性药物支持);影像学或微生物学证实的深部真菌感染(如侵袭性曲霉病、血流感染等);耶氏肺孢子菌肺炎、活动性结核、病毒血症(巨细胞病毒、细小病毒B19等)及病毒性肺炎(巨细胞病毒、COVID-19病毒、流感病毒、腺病毒、副流感病毒等);以及研究者判断的其他可能影响造血功能的严重感染; * 4.血清肌酐或血尿素氮≥正常值上限(ULN)的1.5倍; * 5.丙氨酸氨基转移酶(ALT)或天冬氨酸氨基转移酶(AST)≥ULN的3倍;总胆红素≥ULN的1.5倍; * 6.其他严重和/或未控制的疾病,或经研究者判断可能影响研究参与的情况,包括但不限于:严重的心律或传导异常(如需要临床干预的室性心律失常、二度至三度房室传导阻滞等)、心电图采用Fridericia公式校正的QT间期(QTcF)> 480 ms;纽约心脏病协会(NYHA)心功能分级Ⅲ-Ⅳ级;未控制的糖尿病(糖化血红蛋白[HbA1c] > 9%);难治性高血压;慢性阻塞性肺疾病(第1秒用力呼气容积[FEV1] < 预测值的50%)等; * 7.有动静脉血栓或动脉粥样硬化病史; * 8.抗人类免疫缺陷病毒(HIV)抗体或抗梅毒螺旋体特异性抗体阳性;乙型肝炎表面抗原(HBsAg)阳性;或乙型肝炎核心抗体阳性且乙型肝炎病毒脱氧核糖核酸(HBV-DNA)> ULN;或丙型肝炎病毒核糖核酸(HCV-RNA)> ULN; * 9.有或当前患有恶性实体瘤(已治愈的非浸润性基底细胞癌或皮肤鳞状细胞癌和/或其他已治愈的原位癌除外;已获临床治愈> 5年且5年内无复发的其他恶性肿瘤除外); * 10.异基因造血干细胞移植后6个月内,或供者细胞嵌合率≤ 95%,或存在Ⅱ级及以上活动性急性移植物抗宿主病(aGVHD),或中重度慢性移植物抗宿主病(cGVHD); * 11.首次给药前4周内接种过活疫苗,或计划在研究期间接种任何活疫苗; * 12.妊娠或哺乳期女性患者; * 13.精神疾病患者; * 14.首次给药前4周或5个半衰期(以较长者为准)内参加过任何其他研究药物试验(包括疫苗试验)或暴露于其他研究药物; * 15.拒绝签署知情同意书的患者; * 16.研究者认为不适合纳入研究的其他情况。
Inclusion Criteria Patients must meet all the following criteria to be enrolled in this study: * 1.Voluntarily participate in the study and sign the informed consent form; * 2.Aged ≥ 18 years, regardless of gender; * 3.Patients with acute lymphoblastic leukemia (ALL), lymphoma, or myeloma who still have severe cytopenia (meeting any of the following conditions: absolute neutrophil count ≤ 1×10⁹/L; platelet count ≤ 30×10⁹/L; hemoglobin ≤ 70 g/dL) 3 weeks after CAR-T cell infusion; * 4.ECOG performance status score ≤ 2; * 5.Estimated survival time ≥ 6 months; * 6.For female patients of childbearing potential, a negative pregnancy test result is required. Female patients of childbearing potential and male patients must use highly effective contraceptive measures during the study period and for 4 months/6 months after the discontinuation of treatment, respectively. Exclusion Criteria Patients with any of the following conditions are prohibited from enrolling in this study: * 1.Having received other anti-tumor treatments (including but not limited to chemotherapy, radiotherapy, targeted therapy, immunotherapy, or hematopoietic stem cell transplantation) that may affect the hematopoietic system or blood cell count within 1 month before the screening period after CAR-T cell infusion; * 2.Significant bone marrow infiltration by tumor cells during the screening period (for ALL: bone marrow morphological examination showing leukemia cell proportion \> 5%; for multiple myeloma (MM) and lymphoma: bone marrow flow cytometry showing positive minimal residual disease (MRD), or bone marrow pathological immunohistochemistry showing lymphoma/clonal plasma cell infiltration); * 3.Presence of any of the following conditions within 1 week before the first dose administration: infection with hemodynamic instability (requiring vasoactive drug support); deep fungal infection confirmed by imaging or microbiology (e.g., invasive aspergillosis, bloodstream infection, etc.); Pneumocystis jirovecii pneumonia, active tuberculosis, viremia (cytomegalovirus, parvovirus B19, etc.), and viral pneumonia (cytomegalovirus, COVID-19 virus, influenza virus, adenovirus, parainfluenza virus, etc.); as well as other severe infections that may affect hematopoiesis as judged by the investigator; * 4.Serum creatinine or blood urea nitrogen ≥ 1.5 times the upper limit of normal (ULN); * 5.Alanine aminotransferase (ALT) or aspartate aminotransferase (AST) ≥ 3 times ULN; total bilirubin ≥ 1.5 times ULN; * 6.Other severe and/or uncontrolled diseases, or conditions that may affect study participation as judged by the investigator, including but not limited to: severe cardiac rhythm or conduction abnormalities (e.g., ventricular arrhythmias requiring clinical intervention, second-degree to third-degree atrioventricular block, etc.), corrected QT interval using Fridericia's formula (QTcF) \> 480 ms on electrocardiogram; New York Heart Association (NYHA) heart function classification of Grade Ⅲ-Ⅳ; uncontrolled diabetes mellitus (glycated hemoglobin \[HbA1c\] \> 9%); refractory hypertension; chronic obstructive pulmonary disease (forced expiratory volume in 1 second \[FEV1\] \< 50% of predicted value), etc.; * 7.History of arteriovenous thrombosis or atherosclerosis; * 8.Positive for anti-human immunodeficiency virus (HIV) antibody or anti-Treponema pallidum specific antibody; positive for hepatitis B surface antigen (HBsAg); or positive for hepatitis B core antibody with hepatitis B virus deoxyribonucleic acid (HBV-DNA) \> ULN; or hepatitis C virus ribonucleic acid (HCV-RNA) \> ULN; * 9.A history of or current malignant solid tumor (except cured non-invasive basal cell or squamous cell carcinoma of the skin and/or other cured carcinoma in situ; except other malignant tumors that have achieved clinical cure for \> 5 years with no recurrence within 5 years); * 10.Within 6 months after allogeneic hematopoietic stem cell transplantation, or donor cell chimerism rate ≤ 95%, or presence of active acute graft-versus-host disease (aGVHD) of Grade Ⅱ or higher, or moderate to severe chronic graft-versus-host disease (cGVHD); * 11.Having received a live vaccine within 4 weeks before the first dose administration, or planning to receive any live vaccine during the study period; * 12.Pregnant or lactating female patients; * 13.Patients with mental disorders; * 14.Participation in any other study drug trial (including vaccine trials) or exposure to other study drugs within 4 weeks or 5 half-lives (whichever is longer) before the first dose administration; * 15.Patients who refuse to sign the informed consent form; * 16.Other conditions deemed unsuitable for study inclusion by the investigator.
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:Number of Participants with Treatment-Related Adverse Events as Assessed by CTCAE v5.0 · From recruitment to 24 weeks after the last treatment.
次要终点:Complete Response (CR) rate;Partial Response (PR) rate;Overall Response (OR) rate;Response time;Duration of Relief(DOR)
间充质干细胞:静脉输注,2×10⁶ cells/kg 体重/周(每周一次),根据不同剂量组给予1至4次给药。
本研究是一项单臂、开放标签、探索性临床研究,旨在评估异体脐带血来源间充质干细胞治疗CAR-T疗法后长期血细胞减少症的疗效和安全性。
This study is a single arm, open label, exploratory clinical study aimed at evaluating the efficacy, and safety of allogeneic umbilical cord blood-derived mesenchymal stem cells in the treatment of long-term cytopenia after CAR-T therapy.
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