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:Safety and Efficacy of DIT101 in Relapsed or Refractory Hematologic Malignancies
这是一项 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 15 例。试验地点:中国 · 天津(共 1 个中心,其中中国 1 个)。登记号:NCT07485504。
不限性别 · ≥ 18 Years 且 ≤ 70 Years
纳入标准: • 成年人,年龄18至<70岁,性别不限。 • 自愿签署书面知情同意,并愿意遵守全部研究程序。 • 确诊复发/难治性B细胞急性淋巴细胞白血病/淋巴瘤(B-ALL/LBL),或研究者判断并经合作机构确认的其他复发/难治性血液系统恶性肿瘤。 • 免疫表型证实肿瘤细胞表达目标抗原。 • 筛选时骨髓原始细胞≥5%和/或存在髓外病灶。 • B-ALL/LBL患者须符合复发/难治标准之一:接受≥2个周期标准化疗后仍为原发难治,或多种挽救方案后未达完全缓解;完全缓解后12个月内复发,或完全缓解≥12个月后复发并在后续标准治疗后未缓解;造血干细胞移植后复发;或既往接受靶向同一抗原的CAR-T治疗后复发。 • ECOG体能状态0–2分;预期生存期>3个月。 • 器官功能充分:肌酐清除率>45 mL/min;总胆红素≤ULN的3倍、ALT/AST≤ULN的5倍;PT、APTT或INR≤ULN的1.5倍;1个月内LVEF≥50%;室内空气静息SpO₂≥92%;血液及免疫功能经评估足以耐受研究治疗。 • 有生育能力女性妊娠试验阴性。绝经≥12个月或已接受手术绝育(子宫切除或双侧卵巢切除)者视为无生育能力。 排除标准: • 妊娠或哺乳期。 • 已知遗传性骨髓衰竭综合征,如范可尼贫血、Kostmann综合征、Shwachman综合征或其他已知骨髓衰竭综合征。 • 未控制的活动性中枢神经系统白血病(CNS2或CNS3)。 • 筛选前接受抗肿瘤治疗且尚未达到规定间隔:全身化疗距筛选不足1周;全身免疫/靶向治疗(单抗、双特异性抗体、抗体偶联药物等)末次给药不足5个半衰期或4周(取较短者);供者淋巴细胞输注不足6周;CAR-T治疗或造血干细胞移植不足3个月;放疗不足4周(若骨髓储备>5%且研究者认为不影响资格,可例外)。既往治疗的临床显著毒性未恢复至CTCAE≤1级者也排除,脱发除外。 • 未控制的严重活动性感染。 • 有显著心脏病史,包括NYHA III–IV级心衰、12个月内心肌梗死或PCI/支架置入、不稳定型心绞痛、QTc>480 ms,或研究者判断有临床意义的其他心律失常。 • 过去6个月内有需治疗的中枢神经系统损伤、癫痫发作、卒中或脑出血。 • 活动性病毒感染:HIV抗体阳性、梅毒血清学阳性、HBsAg>10⁶ IU/mL、HCV抗体阳性,或EBV阳性(EBER阳性或病毒拷贝数高于正常)。 • DIT-101输注期间需要长期全身糖皮质激素治疗(局部或吸入激素允许)。 • 需治疗的活动性自身免疫病、免疫缺陷或正在使用免疫抑制治疗。 • 筛选前4周内有急性或中重度慢性移植物抗宿主病(GVHD)。 • 已知对DIT-101任一成分严重过敏。 • 有生育能力的女性或男性无法在DIT-101输注期间及输注后1年内采取有效避孕措施;受试者本人或伴侣计划在输注后1年内妊娠。 • 既往血液系统恶性肿瘤以外的其他恶性肿瘤,但以下情况除外:经根治性治疗且无病≥2年;或非黑色素瘤皮肤癌已充分治疗且目前无病。 • 研究者认为可能增加风险或干扰研究结局的任何情况。
Inclusion Criteria: * Adults aged 18 to \<70 years, any gender. * Voluntarily provide written informed consent and willing to comply with all study procedures. * Diagnosed with relapsed or refractory B-cell acute lymphoblastic leukemia/lymphoma (B-ALL/LBL), or other relapsed/refractory hematologic malignancies as judged by the investigator and confirmed by the collaborating institution. * Tumor cells confirmed positive for the target antigen by immunophenotyping. * Bone marrow blast ≥5% at screening and/or presence of extramedullary disease. * For B-ALL/LBL patients, meets criteria for relapsed/refractory disease, including: * Primary refractory after ≥2 cycles of standard chemotherapy or not achieving CR after multiple salvage regimens; * Relapse within 12 months after CR or ≥12 months relapse after CR not achieving CR after subsequent standard therapy; * Relapse after hematopoietic stem cell transplantation; * Relapse after prior CAR-T therapy targeting the same antigen. * ECOG performance status 0-2. * Expected survival \>3 months. * Adequate organ function, including: * Renal: creatinine clearance \>45 mL/min; * Hepatic: total bilirubin ≤3×ULN, ALT/AST ≤5×ULN; * Coagulation: PT, APTT, or INR ≤1.5×ULN; * Cardiac: LVEF ≥50% within 1 month; * Pulmonary: SpO₂ ≥92% at rest on room air; * Hematologic and immune function considered sufficient to tolerate study treatment. * Women of childbearing potential must have a negative pregnancy test; women considered not of childbearing potential include those who are postmenopausal for ≥12 months or have undergone surgical sterilization (hysterectomy or bilateral oophorectomy). Exclusion Criteria: * Pregnant or breastfeeding women. * Known hereditary bone marrow failure syndromes (e.g., Fanconi anemia, Kostmann syndrome, Shwachman syndrome, or other known marrow failure syndromes). * Uncontrolled active central nervous system leukemia (CNSL; CNS2 or CNS3). * Prior anti-cancer therapy before screening, including: * Systemic chemotherapy within 1 week; * Systemic immunotherapy/targeted therapy (monoclonal antibodies, bispecific antibodies, ADCs, etc.) with last dose \<5 half-lives or \<4 weeks (whichever is shorter); * Donor lymphocyte infusion within 6 weeks; * CAR-T therapy or hematopoietic stem cell transplantation within 3 months; * Radiotherapy within 4 weeks (unless bone marrow reserve \>5% and investigator judges it does not affect eligibility); * Persistent clinically significant toxicity from prior therapy not recovered to ≤CTCAE Grade 1 (except alopecia). * Uncontrolled severe active infection. * History of significant cardiac disease, including: severe heart failure (NYHA class III-IV), myocardial infarction or PCI/stent within 12 months, unstable angina, QTc \>480 ms, or other clinically significant arrhythmia per investigator judgment. * History of CNS injury, seizure, stroke, or brain hemorrhage requiring treatment within 6 months. * Active viral infections: * HIV antibody positive, syphilis serology positive; * HBsAg \>10⁶ IU/mL; * HCV antibody positive; * EBV positive (EBER or copy number above normal). * Need for long-term systemic corticosteroid therapy during DIT-101 infusion (local or inhaled steroids allowed). * Active autoimmune disease requiring treatment, immunodeficiency, or use of immunosuppressive therapy. * Acute or moderate-to-severe chronic graft-versus-host disease (GvHD) within 4 weeks prior to screening. * Known severe allergy to any component of DIT-101. * Women of childbearing potential or men unable to use effective contraception during DIT-101 infusion and for 1 year post-infusion; plans for pregnancy within 1 year post-infusion in male or female subjects or their partners. * Any condition that, in the investigator's opinion, may increase risk or interfere with study outcomes. * Prior malignancy other than hematologic malignancy, except: * Malignancy treated with curative intent and disease-free ≥2 years; * Non-melanoma skin cancer adequately treated with no current evidence of disease.
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:Safety#Incidence and severity of adverse events (AEs) · To evaluate the possible adverse events after DIT101 infusion, including the incidence, and severity of AEs · 2 years after completion of the DIT101 infusion or until death, whichever occurs first.;Safety#Incidence of Dose Limiting Toxicity (DLT) · Incidence of dose limiting toxicities (DLTs) within 28 days after the first DIT101 infusion. · 28 days after the first DIT101 infusion.
次要终点:Duration of Remission (DOR);Event-Free Survival (EFS);Leukemia-Free Survival (LFS);Proportion of Responding Subjects Receiving HSCT;Overall Survival (OS);Maximum Concentration (Cmax) of CAR-T Cells in Peripheral Blood
复发或难治性血液系统恶性肿瘤患者接受1–2次DIT101静脉给药。
这是一项单组、开放标签临床试验,旨在评估DIT101在复发或难治性血液系统恶性肿瘤成人患者中的安全性和耐受性,并探索其潜在抗肿瘤作用。DIT101是一种静脉输注的研究性体内CAR-T细胞疗法,给药后拟在患者体内生成能够识别并攻击肿瘤细胞的CAR-T细胞。与已获批的自体CAR-T疗法不同,DIT101无需采集受试者自身细胞并在体外进行基因改造。研究包括筛选期、DIT101输注治疗期、约6个月的治疗后密集随访期,以及最长2年的长期随访(每3–6个月访视)。
This study is a single-arm, open-label clinical trial designed to evaluate the safety and tolerability of DIT101 in adults with relapsed or refractory hematologic malignancies and to explore its potential anti-tumor effects. DIT101 is an investigational in vivo CAR-T cell therapy administered by intravenous infusion. After administration, it is intended to generate CAR-T cells within the patient's body that can recognize and attack tumor cells. Unlike approved autologous CAR-T therapies, DIT101 does not require collection and ex vivo genetic modification of the participant's own cells. The study includes a screening period, DIT101 infusion treatment, a post-treatment intensive follow-up period of approximately 6 months, and a long-term follow-up period of up to 2 years, with visits every 3-6 months.
MEMBER ACCOUNT
登录成功会直接打开下一页。