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:Exploratory Study on in Vivo CAR-T Therapy Targeting CD20 for the Treatment of Hematological Malignancies
这是一项早期 I 期注册临床试验,评估体内 CAR-T 细胞治疗血液系统恶性肿瘤的安全性、可行性及初步疗效。当前状态:尚未开始招募。计划入组 47 例。登记号:NCT07362602。
不限性别 · ≥ 18 Years 且 ≤ 70 Years
纳入标准: * 1. 年龄范围18-70岁,性别不限; * 2. 预期生存时间超过12周; * 3. 确诊为CD20+B细胞淋巴瘤或淋巴细胞白血病等血液系统肿瘤,并符合相应的既往治疗要求; * 4. 存在可评估病灶(仅适用于淋巴瘤患者); * 5. 东部肿瘤协作组(ECOG)体能状态评分为0或1分;筛选前(基线时)应满足相应要求; * 7. 适龄男女患者必须在进入试验前、研究过程中直至停药后30天内采用可靠的避孕方法;可靠的避孕方法将由主要研究者或指定人员确定; * 8. 能够理解本试验并已签署知情同意书者。 排除标准: * 1. 伴有其他未控制的恶性肿瘤; * 2. 6个月内接受过嵌合抗原受体治疗或其他转基因T细胞治疗; * 3. 已知HIV或乙型肝炎(HBsAg阳性且HBV DNA达到检测限)或丙型肝炎病毒(抗HCV阳性)感染史; * 4. 有CNS淋巴瘤病史、脑脊液中存在恶性细胞或脑转移的受试者; * 5. 心房或心室受累的受试者; * 6. 因肿瘤肿块影响需要紧急处理,如肠梗阻或血管压迫; * 7. 患有冠心病、心绞痛、心肌梗死、心律失常、脑血栓、脑出血、控制不佳的高血压等严重疾病,或其他妨碍参加试验的未控制活动性疾病; * 8. 入组前30天内发生不稳定性肺栓塞、深静脉血栓或其他重大动脉/静脉血栓栓塞事件。如正在接受抗凝治疗,受试者的治疗剂量必须在入组前达到稳定水平; * 9. 器官移植后长期使用免疫抑制剂者,但近期或当前使用吸入性皮质类固醇治疗者除外; * 10. 任何妊娠或哺乳期女性,或计划在治疗期间或治疗后18个月内怀孕的受试者; * 11. 入组前14天内存在需要全身治疗的活动性或不可控制的感染(单纯尿路感染或上呼吸道感染除外)。 * 12. 研究者认为存在任何其他不适合受试者进入本试验的因素。
Inclusion Criteria: * 1\. Age range of 18-70 years old, gender not limited; * 2\. Expected survival time exceeds 12 weeks; * 3\. Diagnosed with blood system tumors such as CD20+B-cell lymphoma or lymphocytic leukemia and meeting the corresponding previous treatment requirements; * 4\. There are assessable lesions (applicable only to lymphoma patients); * 5\. The physical fitness status score of the Eastern Cancer Collaboration Group (ECOG) is 0 or 1 point; Before screening (at baseline), corresponding requirements should be met; * 7\. Male and female patients of appropriate age must use reliable methods of contraception before entering the trial, during the research process until 30 days after discontinuation of medication; Reliable contraceptive methods will be determined by the primary researchers or designated personnel; * 8\. Those who can understand this experiment and have signed the informed consent form. Exclusion Criteria: * 1\. Accompanied by other uncontrolled malignant tumors; * 2\. Received chimeric antigen receptor therapy or other transgenic T cell therapy within 6 months; * 3\. Known history of HIV or hepatitis B (HBsAg positive and HBV DNA reaching the detection limit) or hepatitis C virus (anti HCV positive) infection; * 4\. Participants with a history of CNS lymphoma, malignant cells in cerebrospinal fluid, or brain metastases; * 5\. Participants with atrial or ventricular involvement; * 6\. Emergency treatment is required due to the impact of tumor masses, such as intestinal obstruction or vascular compression; * 7\. Suffering from serious diseases such as coronary heart disease, angina pectoris, myocardial infarction, arrhythmia, cerebral thrombosis, cerebral hemorrhage, poorly controlled hypertension, or other uncontrolled active diseases that hinder participation in the trial; * 8\. Unstable pulmonary embolism, deep vein thrombosis, or other major arterial/venous thromboembolism events occurred within 30 days prior to enrollment. If receiving anticoagulant therapy, the treatment dose of participants must reach a stable level before enrollment; * 9\. For those who have been using immunosuppressants for a long time after organ transplantation, except for recent or current inhaled corticosteroid therapy; * 10\. Any pregnant or breastfeeding woman, or participant who plans to conceive during or within 18 months after treatment; * 11\. Within 14 days prior to enrollment, there is an active or uncontrollable infection that requires systemic treatment (excluding simple urinary tract infections or upper respiratory tract infections). * 12\. The researcher believes that there are any other factors that are not suitable for the study participants to enter this trial.
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:Dose limiting toxicity (DLT) · Within 28 days after the initial treatment;The incidence of adverse effects · Through study completion, an average of 2 years;Maximum tolerated dose (MTD) or optimal biological dose (OBD) · Through study completion, an average of 2 years
次要终点:0bjective response rate (ORR);Disease control rate (DCR);Duration of response (DoR);Progression free survival (PFS)
基于mRNA-LNP的靶向CD20的体内CAR-T药物
基于mRNA-LNP的靶向CD20的体内CAR-T药物
恶性血液肿瘤主要来源于成人B细胞,主要为急性淋巴细胞白血病(ALL)和非霍奇金淋巴瘤(NHL)。总体而言,尽管现有疗法已显著提高大多数患者的生存率,但复发/难治性患者的治疗仍面临重大挑战。CD20是一种在B细胞表面高表达的跨膜蛋白,几乎贯穿B细胞的前体、成熟和活化阶段,但在浆细胞中缺失,使其成为B细胞恶性肿瘤的理想靶点。 近年来,体内CAR-T疗法的突破性发展颠覆了体外CAR-T技术的传统范式。其核心原理是通过基因递送载体将编码嵌合抗原受体(CAR)的基因直接递送至患者体内的T细胞,无需体外分离、修饰和扩增过程,在体内完成T细胞的基因重编程。目前,体内CAR-T疗法的主流载体技术分为两类:慢病毒载体和脂质纳米颗粒(LNP)载体。LNP载体在成本和可及性、安全性以及时效性方面显著突破了传统CAR-T的临床瓶颈。 本试验药物是一种基于CD20的信使核糖核酸(mRNA)治疗药物,是将mRNA负载于脂质纳米颗粒(LNP)上形成的注射液。其在非临床中显示出高效的B细胞清除活性和良好的安全性,支持在B细胞血液恶性肿瘤中进一步开展临床探索。有望为B细胞血液恶性肿瘤提供一种创新、安全且可及的免疫治疗,为更多B细胞血液恶性肿瘤患者带来更好的临床获益。
Malignant hematological tumors mainly derived from adult B cells are mainly acute lymphoblastic leukemia (ALL) and non Hodgkin lymphoma (NHL). Overall, although existing therapies have significantly improved the survival rates of most patients, the treatment of relapsed/refractory patients still faces significant challenges. CD20 is a transmembrane protein highly expressed on the surface of B cells, almost penetrating the precursor, mature, and activated stages of B cells, but lacking in plasma cells, making it an ideal target for B cell malignancies. In recent years, the breakthrough development of in vivo CAR-T therapy has overturned the traditional paradigm of in vitro CAR-T technology. The core principle is to directly deliver the gene encoding chimeric antigen receptor (CAR) to T cells in the patient's body through gene delivery vectors, without the need for in vitro isolation, modification, and amplification processes, and to complete the gene reprogramming of T cells in vivo. At present, the mainstream carrier technologies for CAR-T therapy in vivo are divided into two categories: lentiviral carriers and lipid nanoparticle (LNP) carriers. LNP carriers have significantly broken through the clinical bottlenecks of traditional CAR-T in terms of cost and accessibility, safety, and timeliness. This experimental drug is a CD20 based messenger ribonucleic acid (mRNA) therapeutic drug, which is an injection formed by loading mRNA onto lipid nanoparticles (LNP). It has shown efficient B-cell clearance activity and good safety in non clinical settings, supporting further clinical exploration in B-cell hematological malignancies. It is expected to provide an innovative, safe, and accessible immunotherapy for B-cell hematological malignancies and bring better clinical benefits to more patients with B-cell hematological malignancies.
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