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:In VIVO CAR-T Therapy for Relapsed/Refractory Hematological Malignancies
这是一项 I 期注册临床试验,评估 CAR-T 细胞治疗急性淋巴细胞白血病、淋巴瘤、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 24 例。试验地点:中国 · 昆明(共 1 个中心,其中中国 1 个)。登记号:NCT07239323。
不限性别 · ≥ 18 Years
纳入标准:
1. 年龄≥18岁,性别不限;
2. 确诊为复发/难治性恶性血液肿瘤,包括B-ALL、B细胞淋巴瘤和多发性骨髓瘤;
3. ECOG体能状态评分0-2分,预期生存期≥3个月;
4. 筛选期血常规检查结果符合以下标准:
① 血红蛋白≥6 g/dL(筛选前1周内未输注红细胞),允许使用重组人促红细胞生成素(rhEPO);对于符合血红蛋白≥6 g/dL标准的患者,可通过输注红细胞维持血红蛋白≥6 g/dL;
* 中性粒细胞绝对计数(ANC)≥600/μL(筛选前1周内未使用粒细胞集落刺激因子[G-CSF],或筛选前2周内未使用聚乙二醇化G-CSF);③ 血小板计数≥50,000/μL;④ 淋巴细胞计数≥500/μL;
5. 筛选期肾功能正常:肌酐清除率(CrCl)≥45 mL/min(采用Cockcroft-Gault公式计算);
6. 筛选期肝功能符合以下标准:
① 丙氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)≤3.0×ULN;
② 总胆红素(TBIL)≤2.0×ULN(先天性高胆红素血症如Gilbert综合征除外,直接胆红素可放宽至≤1.5×ULN);
7. 筛选期心功能符合以下标准:
① 左心室射血分数(LVEF)≥40%(经超声心动图或MUGA扫描测定);
② 无临床显著的心包积液;
③ 无临床显著的心电图(ECG)异常;
8. 筛选期肺功能符合以下标准:血氧饱和度(SpO₂)≥90%;
9. 育龄期女性在筛选期及给药前妊娠试验必须为阴性,且不得处于哺乳期;
10. 育龄期男女必须同意自签署知情同意书之日起至研究药物给药结束后1年内采取有效避孕措施,且不得捐献生殖细胞(包括精子或卵子);
11. 受试者或其法定授权代表已签署知情同意书(ICF),表明其了解研究目的和程序并自愿参加本研究。
排除标准:
1. 筛选期内接受过其他抗肿瘤治疗(由研究者综合判断):
① 给药前5个半衰期内接受过化疗、靶向治疗或免疫治疗;
② 给药前4周内接受过放疗(若放疗靶区覆盖骨髓储备≤5%,则不受放疗完成时间限制);
2. 有造血干细胞移植史:在给药前3个月内接受过异基因或自体造血干细胞移植;
3. 有其他恶性肿瘤病史(除本病外),但以下情况除外:
① 接受过根治性治疗,且在入组前≥2年无已知活动性疾病;
② 既往有完全治疗的非黑色素瘤皮肤癌,且目前无活动性病变;
4. 既往接受过与疱疹性口炎病毒糖蛋白(VSVG)假型病毒相关的治疗;
5. 筛选期内有严重且未控制的感染(细菌、病毒、真菌等);
6. 有临床显著的心脏疾病:
* 有症状性心力衰竭或其他严重心脏疾病(如严重心律失常);
* 有纽约心脏病协会(NYHA)III-IV级充血性心力衰竭;③ 在签署知情同意书前6个月内发生过心肌梗死或接受过冠状动脉旁路移植术(CABG)/冠状动脉支架植入术;
* 有临床显著的心室心律失常或不明原因晕厥史;⑤ 有晕厥史(不包括血管迷走性反应或脱水所致者);⑥ 有严重非缺血性心肌病病史;
7. 有其他临床显著的疾病,包括但不限于:
* 原发性免疫缺陷;② 在筛选前6个月内发生过卒中或癫痫发作;
* 有明确的痴呆或精神状态改变的临床证据;④ 有帕金森病、帕金森样运动障碍或上述病史;
8. 在给药前2周内接受过手术,或计划在给药后2周内接受手术(局部麻醉手术除外);
9. 在给药前1个月内接种过减毒活疫苗;
10. 对本产品或其制剂成分有严重过敏反应史;
11. 不适合建立静脉通路的患者;
12. 研究者认为存在其他使患者不适合参加本研究的情况。
Inclusion Criteria:
1. Age ≥ 18 years old, gender unrestricted;
2. Confirmed diagnosis of relapsed/refractory malignant hematological tumors, including B-ALL, B-cell lymphoma and multiple myeloma;
3. ECOG performance status score 0-2, with an expected survival period of ≥ 3 months;
4. Blood routine test results during the screening period meet the following criteria:
① Hemoglobin ≥ 6 g/dL (no red blood cell transfusion within 1 week before screening), recombinant human erythropoietin (rhEPO) is allowed; for patients meeting the hemoglobin ≥ 6 g/dL criterion, red blood cell transfusion can be used to maintain hemoglobin ≥ 6 g/dL;
* Absolute neutrophil count (ANC) ≥ 600/μL (no use of granulocyte colony-stimulating factor \[G-CSF\] within 1 week before screening, or no use of pegylated G-CSF within 2 weeks before screening); ③ Platelet count ≥ 50,000/μL; ④ Lymphocyte count ≥ 500/μL;
5. Normal renal function during the screening period: creatinine clearance rate (CrCl) ≥ 45 mL/min (calculated using the Cockcroft-Gault formula);
6. Liver function during the screening period meets the following criteria:
① Alanine aminotransferase (ALT), aspartate aminotransferase (AST) ≤ 3.0 × ULN;
② Total bilirubin (TBIL) ≤ 2.0 × ULN (except for congenital hyperbilirubinemia such as Gilbert's syndrome, direct bilirubin can be relaxed to ≤ 1.5 × ULN);
7. Cardiac function during the screening period meets the following criteria:
① Left ventricular ejection fraction (LVEF) ≥ 40% (measured by echocardiography or MUGA scan);
② No clinically significant pericardial effusion;
③ No clinically significant electrocardiogram (ECG) abnormalities;
8. Pulmonary function during the screening period meets the following criteria: blood oxygen saturation (SpO₂) ≥ 90%;
9. Women of childbearing age must have a negative pregnancy test during the screening period and before drug administration, and must not be in the lactation period;
10. Men and women of childbearing age must agree to take effective contraceptive measures and not donate reproductive cells (including sperm or eggs) from the time of signing the informed consent form until 1 year after the end of study drug administration;
11. The subject or their legally authorized representative has signed the informed consent form (ICF), indicating their understanding of the purpose and procedures of the study and their voluntary participation in this study.
Exclusion Criteria:
1. Other anti-tumor treatments within the screening period (judged by the investigator comprehensively):
① Received chemotherapy, targeted therapy or immunotherapy within 5 half-lives before administration;
② Received radiotherapy within 4 weeks before administration (if the radiotherapy target area covers ≤ 5% of bone marrow reserve, the time limit for radiotherapy completion is not restricted);
2. History of hematopoietic stem cell transplantation: Received allogeneic or autologous hematopoietic stem cell transplantation within 3 months before administration;
3. History of other malignant tumors (except for this disease), except for the following situations:
① Received radical treatment and had no known active disease for ≥ 2 years before enrollment;
② Had fully treated non-melanoma skin cancer in the past and had no active lesions at present;
4. Received treatment related to vesicular stomatitis virus glycoprotein (VSVG) pseudotyped virus in the past;
5. Had severe and uncontrolled infections (bacterial, viral, fungal, etc.) within the screening period;
6. Clinically significant cardiac diseases:
* Had symptomatic heart failure or other serious cardiac diseases (such as severe arrhythmia);
* Had New York Heart Association (NYHA) Class III-IV congestive heart failure; ③ Had a myocardial infarction or received coronary artery bypass grafting (CABG) / coronary artery stent implantation within 6 months before signing the informed consent;
* Had clinically significant ventricular arrhythmia or a history of unexplained syncope; ⑤ Had a history of syncope (excluding cases caused by vasovagal reactions or dehydration); ⑥ Had a history of severe non-ischemic cardiomyopathy;
7. Other clinically significant diseases, including but not limited to:
* Primary immunodeficiency; ② Had a stroke or seizure within 6 months before screening;
* Had clear clinical evidence of dementia or mental status changes; ④ Had Parkinson's disease, Parkinson-like movement disorders or a history of the above;
8. Had undergone surgery within 2 weeks before administration, or planned to undergo surgery within 2 weeks after administration (local anesthesia surgery excluded);
9. Had received live attenuated vaccines within 1 month before administration;
10. Had a history of severe allergic reactions to this product or its formulation components;
11. Patients who were not suitable for establishing intravenous access;
12. The investigator believed that there were other conditions that made the patient unsuitable for participating in this study.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:Maximal Tolerated Dose(MTD) · MTD will be determined based on Dose-Limiting Toxicity(DLTs) observed during the first 28 days of study treatment. · Up to 28 days after infusion;Incidence of adverse events(AE) after infusion · The frequency, severity, and laboratory findings of all adverse events/serious adverse events are included. · Up to 28 days after infusion
次要终点:Objective Response Rate
本研究是一项由研究者发起的单中心、单臂临床研究,目标人群为复发或难治性恶性血液肿瘤患者。 这是一项针对复发或难治性恶性血液肿瘤治疗的安全性、耐受性和初步疗效的早期探索性临床研究。
This study is an investigator-initiated single center, single arm clinical study with a target population of patients with relapsed or refractory malignant hematological tumors. It is an early exploratory clinical study of the safety, tolerability and initial efficacy in the treatment of relapsed or refractory malignant hematological tumors.
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