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 Naive HBI0101 CAR-T Therapy in Relapsed/Refractory Multiple Myeloma
这是一项 I 期注册临床试验,评估 CAR-T 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 60 例。试验地点:其他 · 耶路撒冷(共 1 个中心)。登记号:NCT07333430。
不限性别 · ≥ 18 Years
纳入标准:
1. 在签署知情同意书时年龄≥18岁。
2. 自愿签署知情同意书。
3. 诊断为复发/难治性多发性骨髓瘤(Part 1a和1b),筛选访视时具有可测量病灶,具体如下:
多发性骨髓瘤(至少符合以下一项标准):
1. 血清M蛋白大于或等于0.5 g/dL。
2. 尿M蛋白大于或等于200 mg/24 h。
3. 血清游离轻链(FLC)检测:受累FLC水平大于或等于3 mg/dL(30 mg/L),且血清FLC比值异常。
4. 活检证实的可评估浆细胞瘤*。
5. 骨髓浆细胞>骨髓总细胞的10%*。
6. 非分泌型患者若经PET-CT或骨髓穿刺确认具有可测量病灶,可允许入组*。
* 筛选访视前最多28天的结果可用于确定合格性。
4. R/R MM受试者必须接受过至少三线既往治疗,包括以下药物:
1. 蛋白酶体抑制剂
2. 免疫调节(IMiDs)药物
3. 抗CD38抗体
5. 对于Part 1a:至少具有以下一项危险因素:a. 髓外病变(EMD)——定义为与骨骼不相连的MM病灶。b. 既往接受过抗BCMA治疗。
6. 美国东部肿瘤协作组(ECOG)体能状态评分0-2。
7. 有生育能力的女性(WCBP),定义为未接受子宫切除术或输卵管结扎术、或未自然绝经至少连续24个月的性成熟女性,必须在治疗前血清妊娠试验阴性。所有性活跃的WCBP和所有性活跃的男性受试者必须同意在整个研究期间使用有效的避孕方法。
8. 既往治疗导致的任何非血液学毒性恢复至≤2级或基线水平,除外脱发和3级神经病变,以及研究者判断为不可逆且预期不会干扰研究治疗或引起安全性担忧的毒性。
9. 能够并愿意遵守研究访视计划及所有方案要求。
10. 对于既往接受过异基因干细胞移植的复发多发性骨髓瘤受试者:在入组研究前至少一个月停止任何免疫抑制治疗且无移植物抗宿主病证据。
排除标准:
1. 存在研究治疗/操作的禁忌症,或预期接受可能妨碍研究操作实施的治疗/操作。
2. 已知的巨块型中枢神经系统疾病。
3. 肝功能不足,定义为天冬氨酸氨基转移酶(AST)和/或丙氨酸氨基转移酶(ALT)>2.5倍正常值上限(ULN)和/或直接胆红素>4倍ULN。
4. 肾功能不足,定义为估算清除率<20(ml/min)。
5. 国际标准化比值(INR)或部分凝血活酶时间(PTT)> 2 x ULN,除非因血栓栓塞事件正在接受稳定剂量的抗凝治疗(前提是该事件不是排除标准)。
6. 骨髓功能不足,定义为中性粒细胞绝对计数(ANC)< 1000 个/mm3、血小板计数 < 30,000 mm3 或血红蛋白 < 8 g/dL。根据研究者判断,绝对淋巴细胞计数 < 300 个/mm3 的受试者可能被排除(由于生产 CART 可能面临挑战)。
7. 左心室射血分数 < 40%。
8. 正在接受慢性免疫抑制剂治疗,如环孢素或全身性类固醇(允许使用生理替代剂量的类固醇,最高可达 12 mg/m2/d 氢化可的松或等效剂量)
9. 研究者判断会将受试者置于过度风险或干扰研究的重大合并症或疾病;示例包括但不限于肝硬化性肝病、脓毒症、近期重大创伤性损伤及其他状况。
10. 已知人类免疫缺陷病毒(HIV)阳性状态。
11. 活动性乙型肝炎活动性感染(定义为 HBS 抗原和 HBV DNA 阳性)或丙型肝炎活动性感染(定义为抗-HCV 和 HCV RNA 阳性)。
12. 活动性 CMV 感染。
13. 已知在 3 个月内有卒中、不稳定型心绞痛、心肌梗死或需要药物或机械控制的室性心律失常病史。
14. 伴有心率未控制的慢性心房颤动。
15. 在过去 2 年内需要治疗或未达到完全缓解的第二原发恶性肿瘤。该排除标准不排除以下受试者:成功治疗的非转移性基底细胞或鳞状细胞皮肤癌,或通过激素治疗得到控制的前列腺癌
16. 曾发生需要抗凝治疗的静脉血栓栓塞事件(例如肺栓塞或深静脉血栓形成)且符合以下任一标准的受试者:
1. 已接受稳定剂量抗凝治疗 < 1 个月(急性导管插入诱导的血栓形成除外。
2. 在过去 30 天内发生过 2、3 或 4 级出血
3. 其静脉血栓栓塞事件症状持续存在(例如持续呼吸困难或需要吸氧)。
17. 妊娠或哺乳期女性。
Inclusion Criteria:
1. ≥18 years of age at the time of signing informed consent.
2. Voluntarily signed informed consent form.
3. Diagnosis of relapsed/refractory multiple myeloma (Parts 1a and 1b), with measurable disease at screening visit as follows:
Multiple Myeloma (at least one of the criteria below):
1. Serum M-protein greater or equal to 0.5 g/dL.
2. Urine M-protein greater or equal to 200 mg/24 h.
3. Serum free light chain (FLC) assay: involved FLC level greater or equal to 3 mg/dL (30 mg/L) provided serum FLC ratio is abnormal.
4. A biopsy-proven evaluable plasmacytoma\*.
5. Bone marrow plasma cells \> 10% of total bone marrow cells\*.
6. Non secretory patient will be allowed provided they have measurable disease by PET-CT or bone marrow aspiration, as designated\*.
* Results pre-dating the Screening visit by up to 28 days may be used to establish eligibility.
4. R/R MM subjects must have been exposed to at least three prior lines of therapy including the following agents:
1. proteasome inhibitor
2. immunomodulatory (IMiDs) agent
3. anti-CD38 antibody
5. For part 1a: At least one of the following risk factors: a. Extra-medullary disease (EMD) - defined as a MM lesion that is not connected to a bone. b. previous exposure to an anti-BCMA therapy.
6. Eastern Cooperative Oncology Group (ECOG) performance status 0 - 2.
7. Women of child-bearing potential (WCBP), defined as a sexually mature woman who has not undergone a hysterectomy or tubal ligation or who has not been naturally postmenopausal for at least 24 consecutive months, must have a negative serum pregnancy test prior to treatment. All sexually active WCBP and all sexually active male subjects must agree to use effective methods of birth control throughout the study.
8. Recovery to ≤ Grade 2 or baseline of any non-hematologic toxicities due to prior treatments, excluding alopecia and Grade 3 neuropathy, and toxicities that are irreversible and not expected to interfere with study treatment or pose safety concerns, per investigator judgement.
9. Ability and willingness to adhere to the study visit schedule and all protocol requirements.
10. For subjects with relapsed multiple myeloma who have previously undergone allogenic stem cell transplantation: no evidence of graft versus host disease after cessation of any immunosuppressive therapy for at least one month before recruitment to the study.
Exclusion Criteria:
1. Contraindication to a study treatment/procedure or is anticipated to receive treatment/procedure that may preclude performance of study procedures.
2. Known bulky central nervous system disease.
3. Inadequate hepatic function defined by aspartate aminotransferase (AST) and/or alanine aminotransferase (ALT) \> 2.5 x upper limit of normal (ULN) and/or direct bilirubin \> 4x ULN.
4. Inadequate renal function defined by estimated clearance of \<20(ml/min).
5. International ratio (INR) or partial thromboplastin time (PTT) \> 2 x ULN, unless on a stable dose of anticoagulant for a thromboembolic event (provided this event is not an exclusion criteria).
6. Inadequate bone marrow function defined by absolute neutrophil count (ANC) \< 1000 cells/mm3, platelet count \< 30,000 mm3, or hemoglobin \< 8 g/dL. Subjects with absolute lymphocyte count \< 300 cells/mm3 may be excluded (due to potential challenges with producing CART), per investigator judgement.
7. Left ventricular ejection fraction \< 40%.
8. Ongoing treatment with chronic immunosuppressant such as cyclosporine or systemic steroids (physiological replacement doses of steroids are allowed up to 12 mg/m2/d hydrocortisone or equivalent)
9. Significant co-morbid condition or disease which in the judgment of the Investigator would place the subject at undue risk or interfere with the study; examples include, but are not limited to, cirrhotic liver disease, sepsis, recent significant traumatic injury, and other conditions.
10. Known human immunodeficiency virus (HIV) positive status.
11. Active Hepatitis B active infection (defined as HBS-antigen and HBV DNA positive) or Hepatitis C active infection (defined as anti-HCV and HCV RNA positive).
12. Active CMV infection.
13. Known history of stroke, unstable angina, myocardial infarction, or ventricular arrhythmia requiring medication or mechanical control within 3 months.
14. Chronic atrial fibrillation with uncontrolled heart rate.
15. Second primary malignancy that has required therapy in the last 2 years or is not in complete remission. This exclusion criterion does not exclude the following subjects: successfully treated non- metastatic basal cell or squamous cell skin carcinoma, or prostate cancer under control with hormonal therapy
16. Subjects who have had a venous thromboembolic event (e.g., pulmonary embolism or deep vein thrombosis) requiring anticoagulation and who meet any of the following criteria:
1. Have been on a stable dose of anticoagulation for \< 1 month (except for acute line insertion induced thrombosis.
2. Have had a Grade 2, 3, or 4 hemorrhage in the last 30 days
3. Are experiencing continued symptoms from their venous thromboembolic event (e.g. continued dyspnea or oxygen requirement).
17. Pregnant or lactating women.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:Determine the Maximum Tolerated Dose (MTD) · MTD will be determined by dose limiting toxicities · 21 days after infusion;Evaluate safety of Naïve HBI0101 CART in Parts 1a and 1b · Incidence of Serious Adverse Events and Adverse Events of Special Interest related to study treatment. · 24 Months after infusion
次要终点:Evaluate clinical response to Naïve HBI0101 CART;Evaluate Overall Survival in participants treated with Naïve HBI0101 CART;Evaluate Progression-Free Survival in participants treated with Naïve HBI0101 CART;Evaluate Duration of Response in participants treated with Naïve HBI0101 CART;Evaluate proportion of MRD negative subjects in participants treated with Naïve HBI0101 CART.;Evaluate persistence of Naïve HBI0101 CART in treated participants
剂量递增阶段(Part 1a)将遵循3+3设计,包括最多3个剂量水平队列。符合队列1、2和3条件的参与者将接受单次(低、中或高)剂量分别为80 × 106 ± 30%、160 × 106 ± 25%和240 × 106 ± 20%的Naïve HBI0101 CART。 扩展阶段(Part 1b)将接受最大耐受剂量(MTD)。
一项1a/1b期开放标签研究,采用剂量递增和扩展阶段,评估初治HBI0101 CART疗法治疗复发/难治性多发性骨髓瘤的安全性和初步疗效。
A Phase 1a/1b Open-Label Study with Dose Escalation and Expansion Phases to Evaluate Safety and Preliminary Efficacy of Naïve HBI0101 CART Therapy for the Treatment of Relapsed/Refractory Multiple Myeloma.
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