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:Clinical Study of Universal CD19 CAR-γδ T Cell Infusion in the Treatment of Relapsed/Refractory Acute B Lymphoblastic Leukemia
这是一项 I 期注册临床试验,评估细胞治疗用于急性淋巴细胞白血病的安全性、可行性及初步疗效。当前状态:尚未开始招募。计划入组 6 例。试验地点:中国 · 福州(共 1 个中心,其中中国 1 个)。登记号:NCT07491263。
不限性别 · ≥ 14 Years
纳入标准: * 年龄>14岁,性别不限; * 临床诊断为复发/难治性急性B淋巴细胞白血病,骨髓原始/幼稚淋巴细胞比例≥5%(形态学)(单纯髓外受累者除外),且符合以下任一条件: 1. 经2个周期标准化疗未达CR; 2. 初次诱导达CR,但CR持续时间≤12个月; 3. 复发/难治性B-ALL,对一线或多线挽救治疗无效; 4. 造血干细胞移植后复发,包括血液学复发和微小残留病(MRD)阳性; 5. 无标准治疗方案的患者。 * 细胞学或组织学证实肿瘤细胞免疫表型为CD19阳性; * 预期生存时间超过3个月; * 东部肿瘤协作组(ECOG)体能状态评分为0-2分; * 关键器官功能符合以下标准:超声心动图左心室射血分数≥50%;血清肌酐≤1.5×正常值上限(ULN);丙氨酸氨基转移酶(ALT)和天冬氨酸氨基转移酶(AST)≤3×ULN;总胆红素≤1.5×ULN; * 育龄期女性妊娠试验阴性;男性和女性均同意在治疗期间及治疗后1年内采取有效避孕措施; * 既往抗肿瘤治疗毒性≤1级(根据CTCAE v5.0)或按纳入/排除标准处于可接受水平; * 无重大遗传性疾病; * 能够理解试验要求和流程,并愿意按要求参加临床研究; * 签署试验知情同意书 排除标准: * 存在中枢神经系统(CNS)受累或具有临床意义的CNS疾病史,如癫痫和脑血管疾病; * 妊娠或哺乳期女性,或不同意在治疗期间及治疗后1年内采取有效避孕措施的女性; * 其他未缓解的恶性肿瘤; * 原发性免疫缺陷或需要免疫抑制治疗的自身免疫性疾病患者; * 入组前6个月内接受过异基因免疫细胞治疗,或入组前6周内接受过供者淋巴细胞输注的患者; * 患者血清中抗FMC63和DSA反应确认为阳性; * 入组前4周内参加过其他临床试验的患者; * 未控制的感染性疾病或其他严重情况,包括但不限于感染(人类免疫缺陷病毒、急性或慢性活动性乙型或丙型肝炎)、充血性心力衰竭、不稳定型心绞痛、心律失常,或经治医生认为存在不可预测风险的情况; * 入组前3个月内有卒中或颅内出血史; * 入组前28天内有大手术或创伤,或主要副作用尚未恢复; * 对细胞产品任何成分有过敏史; * 无法理解或不愿签署知情同意书; * 研究者认为不适合参加临床试验的其他原因。
Inclusion Criteria: * Age \> 14 years, gender unrestricted; * Clinically diagnosed with relapsed/refractory acute B-lymphoblastic leukemia, with bone marrow blast/immature lymphocyte proportion ≥5% (morphology) (excluding cases with isolated extramedullary involvement), meeting any of the following criteria: 1. Failure to achieve CR after 2 cycles of standard chemotherapy; 2. Initial induction achieved CR, but CR duration ≤12 months; 3. Relapsed/refractory B-ALL refractory to first or multiple salvage therapies; 4. Post-hematopoietic stem cell transplantation relapse, including hematological relapse and minimal residual disease (MRD) positivity; 5. Patients for whom no standard therapy exists. * Cytology or histology confirms tumor cell immunophenotype as CD19-positive; * Expected survival time exceeding 3 months; * Eastern Cooperative Oncology Group (ECOG) performance status score of 0-2; * Key organ functions meeting the following criteria: left ventricular ejection fraction ≥50% by echocardiography; serum creatinine ≤1.5 × upper limit of normal (ULN); alanine aminotransferase (ALT) and aspartate aminotransferase (AST) ≤3 × ULN; total bilirubin ≤1.5 × ULN; * Negative pregnancy test for women of childbearing potential; both males and females agree to use effective contraception during treatment and for 1 year thereafter; * Toxicity from prior anti-tumor therapy ≤ Grade 1 (according to CTCAE v5.0) or at an acceptable level per inclusion/exclusion criteria; * No significant hereditary diseases; * Able to comprehend the trial requirements and procedures, and willing to participate in the clinical study as required; * Signed informed consent form for the trial Exclusion Criteria: * Presence of central nervous system (CNS) involvement or a clinically significant history of CNS diseases, such as epilepsy and cerebrovascular diseases; * Pregnant or lactating women, or women who disagree to use effective contraception during treatment and within 1 year after treatment; * Other malignancies that are not in remission; * Patients with primary immunodeficiency or autoimmune diseases requiring immunosuppressive therapy; * Patients who have received allogeneic immune cell therapy within 6 months before enrollment, or donor lymphocyte infusion within 6 weeks before enrollment; * Confirmed positive anti-FMC63 and DSA responses in the patient's serum; * Patients who have participated in other clinical trials within 4 weeks before enrollment; * Uncontrolled infectious diseases or other serious conditions, including but not limited to infections (human immunodeficiency virus, acute or chronic active hepatitis B or C), congestive heart failure, unstable angina, arrhythmia, or conditions considered by the treating physician to pose unpredictable risks; * History of stroke or intracranial hemorrhage within 3 months before enrollment; * Major surgery or trauma within 28 days before enrollment, or main side effects not yet recovered; * History of allergy to any component of the cell product; * Inability to understand or unwillingness to sign the informed consent form; * Other reasons deemed by the researchers as unsuitable for the clinical 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:Adverse Event · 12 months;Incidence of Dose-Limiting Toxicities (DLTs) · DLT was defined as QH103 Cells-related events with onset within first 28 days following infusion. · 28 days
次要终点:PK(Pharmacokinetics):Number and Copy Number of CD19 CAR-γδT cells;PK: Persistence of CD19 CAR-γδT;PD(Pharmacodynamics) :Changes in Various Cytokine Levels (IL-2, IL-4, IL-6, IFN-γ, TNF α, etc.) from Baseline
将给予氟达拉滨和环磷酰胺的条件性化疗方案,随后进行研究性治疗,QH103细胞 干预措施: 生物制剂:QH103细胞注射液 药物:氟达拉滨 药物:环磷酰胺
本研究是一项开放标签、单臂临床试验,旨在评估QH103细胞输注在CD19阳性R/R B-ALL受试者中的安全性和耐受性。
This study is an open-label, single-arm clinical trial designed to evaluate the safety and tolerability of QH103 cell infusion in subjects with CD19-positive R/R B-ALL.
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