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:CAR BCMA-70 CAR-T Cells for the Treatment of High-risk Plasma Cell Neoplasms
这是一项早期 I 期注册临床试验,评估 BCMAT 细胞治疗浆细胞肿瘤的安全性、可行性及初步疗效。当前状态:招募中。计划入组 20 例。试验地点:中国 · 北京(共 1 个中心,其中中国 1 个)。登记号:NCT07416682。
不限性别 · ≥ 18 Years 且 ≤ 75 Years
纳入标准: 1. 受试者或其法定代理人已提供书面知情同意,并愿意且能够遵守所有计划访视、研究治疗给药、实验室检查及其他所需试验程序; 2. 临床诊断为高危浆细胞肿瘤,且符合以下任一分子/细胞遗传学或临床标准: 1. 17号染色体短臂缺失(del[17p]),克隆比例≥20%,和/或存在TP53基因突变; 2. IgH易位[t(4;14)、t(14;16)或t(14;20)]合并1q扩增(1q+)和/或1号染色体短臂缺失(del[1p32]); 3. 1号染色体异常:单等位基因del(1p32)合并1q+,或双等位基因del(1p32); 4. β₂-微球蛋白≥5.5 mg/L且血清肌酐正常(<1.2 mg/dL)。 3. 年龄18–75岁(含),男女均可; 4. ECOG体能状态评分0–2分; 5. 自签署知情同意书之日起预期生存期>3个月; 6. 血红蛋白(HGB)≥60 g/L(允许输血); 7. 肝、肾及心肺功能符合以下要求:血清肌酐≤2×ULN;左心室射血分数(LVEF)≥50%;血氧饱和度>90%;总胆红素≤1.5×ULN,ALT和AST≤2.5×ULN; 8. 受试者同意自签署知情同意书起至CAR-T细胞输注后1年内采取高效避孕措施。 排除标准: 1. 左心室射血分数<50%的严重心功能不全; 2. 有导致肺功能受损的严重慢性肺病史; 3. 同时患有目标浆细胞肿瘤以外的活动性或进展性恶性肿瘤; 4. 合并严重感染且无法通过标准治疗有效控制; 5. 合并严重自身免疫性疾病或先天性免疫缺陷; 6. 活动性病毒性肝炎,定义为HBV-DNA或HCV-RNA水平高于检测下限; 7. HIV感染、已知AIDS或梅毒感染; 8. 对生物制品(包括抗生素)有严重过敏反应史; 9. 异基因造血干细胞移植(allo-HSCT)受者停用免疫抑制治疗1个月后急性移植物抗宿主病(aGVHD)仍未消退; 10. 存在其他可能增加参加研究风险、干扰研究结局或经研究者判断不适合入组的严重躯体/精神疾病或显著实验室异常; 11. 有生育能力的女性受试者处于妊娠期或哺乳期。
Inclusion Criteria: 1. The subject or their legally acceptable representative has provided written informed consent and is willing and able to comply with all scheduled study visits, study treatment administration, laboratory tests, and other required trial procedures. 2. Clinically diagnosed with high-risk plasma cell neoplasm, meeting any one of the following molecular/cytogenetic or clinical criteria: 1. Deletion of the short arm of chromosome 17 (del(17p)) with clonal proportion ≥ 20%, and/or TP53 gene mutation; 2. IgH translocation (t(4;14), t(14;16), or t(14;20)) combined with 1q amplification (1q+) and/or deletion of the short arm of chromosome 1 (del(1p32)); 3. Chromosome 1 abnormalities: monoallelic del(1p32) plus 1q+, or biallelic del(1p32); 4. β₂-microglobulin ≥ 5.5 mg/L with normal serum creatinine (\< 1.2 mg/dL). 3. Age 18 to 75 years (inclusive), male or female. 4. Eastern Cooperative Oncology Group (ECOG) performance status score of 0-2. 5. Life expectancy \> 3 months from the date of signed informed consent. 6. Hemoglobin (HGB) ≥ 60 g/L (transfusion permitted). 7. Adequate hepatic, renal, and cardiopulmonary function as defined by: 1. Serum creatinine ≤ 2 × ULN; 2. Left ventricular ejection fraction (LVEF%) ≥ 50%; 3. Blood oxygen saturation \> 90%; 4. Total bilirubin ≤ 1.5 × ULN; ALT and AST ≤ 2.5 × ULN. 8. Subject agrees to use highly effective contraception from the date of informed consent until 1 year after CAR-T cell infusion. Exclusion Criteria: 1. Severe cardiac insufficiency with left ventricular ejection fraction (LVEF%) \< 50%. 2. History of severe chronic lung disease associated with impaired pulmonary function. 3. Concurrent active or progressive malignant tumors other than the target plasma cell neoplasm. 4. Concurrent severe infection that cannot be effectively controlled with standard therapy. 5. Concurrent severe autoimmune disease or congenital immunodeficiency disorders. 6. Active viral hepatitis, defined as hepatitis B virus DNA (HBV-DNA) or hepatitis C virus RNA (HCV-RNA) levels above the lower limit of detection (LLOD). 7. Human immunodeficiency virus (HIV) infection, known acquired immunodeficiency syndrome (AIDS), or syphilis infection. 8. History of severe allergic reactions to biological products, including antibiotics. 9. Recipients of allogeneic hematopoietic stem cell transplantation (allo-HSCT) with persistent acute graft-versus-host disease (aGVHD) that does not resolve within 1 month after discontinuing immunosuppressive therapy. 10. Presence of other severe physical or psychiatric illnesses, or significant laboratory abnormalities, that may increase the risks of study participation, interfere with study outcomes, or render the subject otherwise unsuitable for enrollment as determined by the investigator. 11. Female subjects of childbearing potential who are 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:According to the incidence of treatment-related adverse events (AEs) to evaluate the safetyof CAR BCMA-CD70 CAR-T cells in the treatment of CD70/BCMA positive high-risk plasma cell neoplasms. · Incidence of treatment-related adverse events (AEs) Description: Number and severity of adverse events graded according to CTCAE v5.0, including cytokine release syndrome (CRS) graded by ASTCT criteria and immune effector cell-associated neurotoxicity syndrome (ICANS) graded by ASBMT criteria · up to 3 years;According to the determine the Maximal Tolerable Dose(MTD) to evaluate the safety of CAR BCMA-CD70 CAR-T cells in the treatment of CD70/BCMA positive high-risk plasma cell neoplasms. · MTD will be determined based on DLTs observed during the first 28 days of study treatment
次要终点:According to the objective response rate (ORR) to evaluate the efficacy of CAR BCMA-CD70 CAR-T cells in the treatment of CD70/BCMA positive high-risk plasma cell neoplasms.
研究性治疗:CAR BCMA-CD70 T细胞。研究产品为CAR BCMA-CD70 T细胞,经静脉注射。输注BCMA-CD70 CAR-T细胞前,联合给予氟达拉滨和环磷酰胺进行淋巴细胞清除性化疗。
这是一项单臂研究,评估CAR BCMA-CD70 CAR-T细胞治疗高危浆细胞肿瘤的安全性和有效性。
This is a single arm study to evaluate the safety and efficacy of CAR BCMA-CD70 CAR-T cell therapy for high-risk plasma cell neoplasms.
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