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:GP350 CAR-T for Relapse/Refractory and Epstein-Barr Virus Infection Associated Lymphoid Neoplasms
这是一项 I/II 期注册临床试验,评估 CAR-T 细胞治疗肿瘤的安全性、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 · 合肥(共 1 个中心,其中中国 1 个)。登记号:NCT07306156。
不限性别 · ≥ 18 Years 且 ≤ 70 Years
纳入标准: 1. 诊断:依据WHO-HAEM5分类确诊淋巴系统肿瘤(Alaggio R.等,doi:10.1038/s41375-022-01620-2)。 2. 疾病评估: 1) 复发/难治性淋巴系统肿瘤,符合以下任一项:按Lugano标准接受2个周期标准一线治疗后未达到至少部分缓解(PR);一线治疗缓解后6个月内进展,或对原一线/二线方案未缓解且治疗6个月后仍进展;造血干细胞移植后复发。 2) EBV感染,符合以下任一项:定量PCR检测外周血(血浆或全血)EBV DNA≥10³ copies/mL;免疫组化或流式细胞术显示肿瘤细胞GP350阳性(≥10%);EBV抗体血清学符合以下任一情况:抗VCA-IgM阳性、抗EA-IgG阳性,或抗VCA-IgM、抗VCA-IgG和抗EBNA-IgG同时阳性。 3) 至少有1个符合Lugano标准的可评估淋巴瘤病灶,或有确诊的EBV活动性裂解感染。 3. 体能状态:ECOG评分0–2分,预期生存期≥3个月。 4. 年龄18–70岁,不限性别。 5. 血液学指标:中性粒细胞绝对计数(ANC)≥1.0×10⁹/L;血红蛋白>60 g/L;CD3+ T细胞计数>0.5×10⁹/L;血小板>30×10⁹/L。 6. 器官功能:肌酐清除率≥60 mL/min;ALT/AST≤正常值上限(ULN)2倍;总胆红素≤ULN的2倍;左室射血分数(LVEF)≥50%,无心包积液且心电图无有临床意义的异常;无或仅有少量胸腔积液/腹水;血氧饱和度≥95%。 7. 避孕:有生育能力的女性须妊娠试验阴性,并同意避孕至末次随访;男性参与者若伴侣有生育能力,也须同意避孕至末次随访。 8. 知情同意:心理状态稳定,能够理解研究目的和程序,自愿参加,能够签署知情同意书并遵守方案要求。 排除标准: 1. 活动性感染:存在甲型、乙型或丙型肝炎活动性感染,或其他未控制的严重活动性感染(EBV感染除外)。 2. 免疫抑制:有获得性免疫缺陷综合征(AIDS)病史;或因其他疾病长期使用免疫抑制剂(包括泼尼松等效剂量>15 mg/日的皮质类固醇)。 3. 心功能异常:NYHA心功能III或IV级充血性心力衰竭;过去6个月内发生心肌梗死或接受冠状动脉旁路移植术;有临床意义的室性心律失常或不明原因晕厥;有严重非缺血性心肌病史;单采前8周内有心功能不全(LVEF<45%)。 4. 妊娠/避孕:妊娠或哺乳期女性;男性或女性参与者不愿避孕。 5. 肝肾功能损害:AST/ALT>ULN的3倍;总胆红素>ULN的3倍;肌酐清除率<60 mL/min。 6. 对任何研究药物有严重超敏反应史。 7. 既往接受干细胞移植者,移植后须已停用免疫抑制剂>6周且无移植物抗宿主病(GVHD)表现。 8. 研究者判断不适合参加研究的其他情况(如凝血障碍、溶血性贫血等)。
Inclusion Criteria: 1. Diagnosis: Confirmed diagnosis of lymphoid neoplasms according to WHO-HAEM5 (Alaggio R. et al. doi:10.1038/s41375-022-01620-2); 2. Disease Assessment: 1. Criteria for Relapsed/Refractory lymphoid neoplasms: Meeting any one of the following three conditions: ① Failure to achieve at least a partial response (PR) per Lugano criteria after two cycles of standard first-line therapy; ② Disease progression within six months after achieving a response to first-line therapy, or progression after six months with no response to the original first-line or second-line regimen; ③ Relapse after hematopoietic stem cell transplantation. 2. Criteria for EBV Infection: Meeting any one of the following three conditions: ① Peripheral blood (plasma or whole blood) EBV DNA load ≥ 10³ copies/ml by quantitative PCR; ②Tumor cell GP350 positivity (≥10% of tumor cells by immunohistochemistry or flow cytometry); ③ Serological detection of EBV antibodies indicating any of the following: positive anti-VCA-IgM; positive anti-EA-IgG; or simultaneous positivity for anti-VCA-IgM, anti-VCA-IgG, and anti-EBNA-IgG. 3. At least one evaluable lymphoma lesion according to Lugano criteria, or confirmed active lytic EBV infection. 3. Performance Status: ECOG score 0-2 and expected survival ≥3 months; 4. Age: 18-70 years, regardless of sex; 5. Hematologic Criteria: * Absolute neutrophil count (ANC) ≥1.0×10⁹/L; * Hemoglobin \>60 g/L; * CD3+ T-cell count \>0.5×10⁹/L; * Platelet count \>30×10⁹/L; 6. Organ Function: * Creatinine clearance ≥60 mL/min; * ALT/AST ≤2× upper limit of normal (ULN); * Total bilirubin ≤2× ULN; * Left ventricular ejection fraction (LVEF) ≥50%, no pericardial effusion, and no clinically significant ECG abnormalities; * Minimal or no pleural/ascitic fluid; * Oxygen saturation ≥95%; 7. Contraception: * Women of childbearing potential must have a negative pregnancy test and agree to use effective contraception until the last follow-up; * Male participants with fertile partners must agree to use effective contraception until the last follow-up; 8. Informed Consent: Psychologically stable, capable of understanding the study's purpose and procedures, willing to participate voluntarily, and able to provide signed informed consent and comply with protocol requirements. Exclusion Criteria: 1. Active Infections: Presence of active hepatitis A, B, or C infection, or other uncontrolled severe active infections (excluding EBV infection); 2. Immunosuppression: * History of acquired immunodeficiency syndrome (AIDS); * Chronic use of immunosuppressants (including corticosteroids at doses equivalent to \>15 mg/day of prednisone) for other conditions; 3. Cardiac Dysfunction: 1. NYHA Class III or IV congestive heart failure; 2. Myocardial infarction or coronary artery bypass grafting within the past 6 months; 3. Clinically significant ventricular arrhythmia or unexplained syncope; 4. History of severe non-ischemic cardiomyopathy; 5. Cardiac insufficiency (left ventricular ejection fraction \<45%) within 8 weeks prior to apheresis; 4. Pregnancy/Contraception: * Pregnant or lactating women; * Participants (male or female) unwilling to use contraception; 5. Hepatic/Renal Impairment: * AST/ALT \>3× upper limit of normal (ULN); * Total bilirubin \>3× ULN; * Creatinine clearance \<60 mL/min; 6. Allergies: History of severe hypersensitivity to any study drugs; 7. Prior Stem Cell Transplant: Must have discontinued immunosuppressants for \>6 weeks post-transplant with no signs of graft-versus-host disease (GVHD); 8. Other Exclusionary Conditions: Any other condition deemed unsuitable by the investigator (e.g., coagulation disorders, hemolytic anemia, etc.).
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:Overall Response Rate (ORR) · The percentage of patients with complete response (CR) and partial response (PR) according to the RECIL 2017 criteria determined by the study investigators · Month 12 post CAR-T infusion;EBV DNA clearance rate · Defined as the proportion of patients achieving two consecutive negative tests in plasma or whole blood at least 7 days apart following treatment, relative to the total treated population · Month 12 post CAR-T infusion;Treatment Emergent Adverse Event (TEAE) · TEAE is defined as an adverse event that occurs or worsens after receiving the first dose of the trial drug · Within 3 months post-infusion
次要终点:Progression-Free Survival (PFS);Overall Survival (OS)
未提供该组干预措施的进一步说明。
这是一项I/II期、开放标签、单臂临床研究,评估GP350 CAR-T治疗复发/难治性及EB病毒感染相关淋巴系统肿瘤的效果。入组后,参与者将接受白细胞单采、预处理化疗和CAR-T细胞静脉输注,随后进行治疗后评估及长期随访。研究流程包括筛查、入组/白细胞单采、预处理化疗、CAR-T治疗、治疗后评估和长期随访。
This is a Phase 1/Phase 2 open-label, single-arm clinical study of GP350 CAR-T for Relapse/Refractory and Epstein-Barr virus infection associated lymphoid neoplasms. Each participant will undergo leukapheresis after enrolment, receive treatment of the conditioning chemotherapy, and an intravenous infusion of CAR-T cells. Each participant will proceed through the following study procedures: * Screening * Enrollment/Leukapheresis * Conditioning chemotherapy * CAR T treatment * Post-treatment assessment * Long-term follow-up
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