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:Study of Allo-QuadCAR01-T, an Allogeneic CAR-T Targeting CD19/CD20, in Patients With Relapsed or Refractory B-Cell Malignancies
这是一项 I/II 期注册临床试验,评估细胞治疗用于淋巴瘤、白血病的安全性、可行性及初步疗效。当前状态:招募中。计划入组 178 例。试验地点:美国 · 芝加哥、埃文斯顿、普罗维登斯、纳什维尔(共 13 个中心)。登记号:NCT07284433。
不限性别 · ≥ 18 Years
纳入标准:成人,年龄≥18岁;确诊复发/难治性B细胞非霍奇金淋巴瘤(B-NHL)或慢性淋巴细胞白血病(CLL);既往至少接受2线治疗;ECOG 0–1;心、肝、肾功能充分;与供者细胞HLA B/C匹配;无活动性未控制感染。 排除标准:剂量递增队列中有活动性CNS受累(包括原发CNS淋巴瘤;后续队列经申办方批准后可能允许);筛查前3个月内接受CAR-T,或既往CAR-T后发生≥3级免疫效应细胞相关血液学毒性(ICAHT);3个月内自体干细胞移植;既往异基因干细胞/实体器官移植;既往接受双靶点CD19/CD20 CAR-T;对试验药或类似化合物有严重超敏反应;GvHD或移植后淋巴增殖性疾病史;La/SS-B自身抗体或相关自身免疫病;可能干扰试验的其他恶性肿瘤,但以下除外:根治治疗的基底/鳞状细胞皮肤癌或宫颈原位癌;无需治疗的低级别早期前列腺癌(Gleason≤6、I–II期);非转移性乳腺癌辅助内分泌治疗≥2年;或其他已根治且缓解≥2年的恶性肿瘤。筛查前1周内活动性病毒感染,或严重细菌/真菌感染;出血性膀胱炎;活动性神经自身免疫病(如多发性硬化、格林-巴利综合征、肌萎缩侧索硬化);活动性或残留HBV、HCV或梅毒;活动性HIV(既往HIV史在申办方批准下可能符合条件)。过去6个月内有神经系统疾病(如卒中、痴呆、帕金森病、小脑病或CNS自身免疫病);过去6个月内有重大心脏病(如心肌梗死、支架、不稳定型心绞痛);原发性免疫缺陷或过去1年需全身治疗的自身免疫病(稳定且经申办方批准者除外);既往治疗未恢复的≥2级非血液学毒性(≤2级神经病变除外);28天内全身免疫抑制治疗;末次系统性淋巴瘤/CLL标准或试验治疗距入组<28天或不足5个半衰期;14天内重大手术;28天内局部放疗或活疫苗;妊娠或哺乳。
Inclusion Criteria: * Adults 18 years or older. * Diagnosed with relapsed or refractory B-cell non-Hodgkin lymphoma (B-NHL) or chronic lymphocytic leukemia (CLL). * Must have received at least 2 prior lines of therapy. * ECOG performance status 0-1 (able to carry out daily activities). * Adequate organ function (heart, liver, kidneys). * HLA B/C match with donor cells. * No active uncontrolled infections. Exclusion Criteria: * Active CNS involvement (including PCNSL) in dose escalation cohorts; may be allowed in later cohorts with Sponsor approval. * Prior CAR-T within 3 months of screening, or ≥Grade 3 ICAHT from prior CAR-T. * Autologous stem cell transplant within 3 months. * Prior allogeneic stem cell transplant or solid organ transplant. * Prior therapy with dual CD19/CD20 CAR-T. * Severe hypersensitivity to trial agents or similar compounds. * History of GvHD or post-transplant lymphoproliferative disorder. * Presence of La/SS-B autoantibodies or related autoimmune diseases. * Other malignancy that may interfere with trial, except: * Curatively treated basal/squamous skin cancer or cervical carcinoma in situ * Low-grade, early-stage prostate cancer (Gleason ≤6, Stage 1-2) with no therapy needed * Adjuvant endocrine therapy for non-metastatic breast cancer (≥2 years) * Any other curatively treated malignancy in remission ≥2 years * Active viral infection within 1 week of screening, or serious bacterial/fungal infection. * Hemorrhagic cystitis. * Active neuro-autoimmune disease (e.g., MS, Guillain-Barré, ALS). * Active or residual HBV, HCV, or syphilis. * Active HIV. History of HIV may be eligible with Sponsor approval if: * Neurological disorders within 6 months (e.g., stroke, dementia, Parkinson's, cerebellar disease, CNS autoimmune disease). * Significant cardiac disease within 6 months (e.g., MI, stent, unstable angina). * Primary immunodeficiency or autoimmune disease requiring systemic treatment within 1 year (unless stable and Sponsor-approved). * Unresolved ≥Grade 2 non-hematologic toxicity from prior therapy (except neuropathy up to Grade 2). * Systemic immunosuppression within 28 days. * Last systemic lymphoma/CLL therapy (standard or investigational) within 28 days or 5 half-lives. * Major surgery within 14 days. * Local radiation within 28 days. * Live vaccination within 28 days. * Pregnant or breastfeeding.
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 AEs defined as DLTs · Incidence and intensity of adverse events (AEs) graded according to Common Terminology Criteria for Adverse Events (CTCAE) Version 5.0, except for cytokine release syndrome (CRS), immune effector cell associated neurotoxicity syndrome (ICANS), tumor lysis syndrome, and graft versus host disease (GvHD), which will be graded according to widely accepted specialized criteria · At the end of cycle 1 (in total 28 days, given no treatment interruptions);To determine the maximum tolerated dose (MTD) · MTD · At the End of Cycle 1 (in total 28 days, given no treatment interruptions);To determine the incidence of dose-limiting toxicities (DLT) · Incidence of DLTs · At the end of cycle 1 (in total 28 days, given no treatment interruptions);Phase 2: Complete response rate (CRR) · Complete remission rate is defined as the proportion of participants with complete remission, per international working group (IWG) Lugano classification, as assessed by the investigator. · Up to week 13
次要终点:Pharmacokinetics of Allo-QuadCAR01-T in PB in patients after infusion of Allo-QuadCAR01-T;To investigate the impact of Allo-QuadCAR01-T on MRD;To evaluate immunogenicity against Allo-QuadCAR01-T;To evaluate host immune cell depletion and reconstitution resulting from LD;Overall Response Rate (ORR);Progression-Free Survival (PFS);Duration of Response (DOR);Overall Survival (OS)
Ia期(剂量递增):复发/难治性B细胞恶性肿瘤患者接受淋巴清除化疗后单次输注Allo-QuadCAR01-T。Ib期(扩展):剂量递增后,更多复发/难治性B细胞淋巴瘤患者接受淋巴清除化疗,并按Ia期一个或多个可耐受剂量水平单次输注Allo-QuadCAR01-T。II期:复发/难治性DLBCL患者接受淋巴清除化疗后,按II期推荐剂量单次输注Allo-QuadCAR01-T。主要终点为第13周完全缓解率,次要终点包括缓解持续时间、无进展生存期和总生存期。
本研究评估Allo-QuadCAR01-T,一种现货型异基因CAR-T疗法,用于难治性B细胞肿瘤。与使用患者自身细胞的常规CAR-T不同,该疗法使用预先制备的供者细胞,旨在缩短等待时间并降低成本。其靶向CD19和CD20以降低复发风险,并通过基因编辑提高安全性。研究分三阶段:先确定安全剂量,再确认剂量,最后在DLBCL患者中评估疗效。患者接受预处理化疗后单次输注;主要目标是评估安全性及第13周完全缓解率。计划约160例,随访最长15年。
This study is testing Allo-QuadCAR01-T, a new off-the-shelf CAR-T therapy for people with hard-to-treat B-cell cancers. Unlike current CAR-T treatments that use a patient's own cells, this therapy uses donor cells that are ready to use, which can save time and reduce costs. It targets two proteins, CD19 and CD20, to lower the chance of relapse and uses gene editing to make it safer. The trial has three parts: first to find a safe dose, then to confirm it, and finally to test how well it works in patients with diffuse large B-cell lymphoma (DLBCL). Patients will get one infusion after chemotherapy to prepare their body. The main goal is to check safety and see how many patients have a complete response by Week 13. About 160 patients will take part, and researchers will follow them for up to 15 years.
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