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:Efficacy and Safety of CD19/CD20 CAR/TRuC-T in Relapsed/Refractory B-Cell Lymphoma
这是一项 I/II 期注册临床试验,评估细胞治疗用于 B 细胞淋巴瘤的安全性、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 · 深圳(共 1 个中心,其中中国 1 个)。登记号:NCT07508605。
不限性别 · ≥ 18 Years 且 ≤ 75 Years
纳入标准: 受试者须满足以下全部条件方可入组: 1. 年龄18~75岁,性别不限。 2. 根据WHO 2020年分类,组织学确诊为复发/难治性B细胞淋巴瘤。 3. ECOG体能状态评分0~2分。 4. 预期生存期至少3个月。 5. 经流式细胞术和/或免疫组化证实肿瘤细胞表达CD20。 6. 对CD19 CAR-T细胞治疗耐药/难治,或CD19表达低。 7. 无严重心、肺、肝或肾疾病。 8. 能够理解并愿意签署本研究知情同意书。 9. 无外周血单个核细胞采集/单采禁忌证。 10. 根据RECIST 1.1至少有1个可测量且可评估病灶。 11. 既往接受过标准一线和二线治疗。 12. 细胞治疗前2周内未接受抗体类治疗。 排除标准: 符合以下任一条件者排除: 1. 对细胞产品中任何成分有过敏史。 2. 全血细胞计数异常,符合以下任一项:白细胞≤1×10⁹/L、中性粒细胞绝对计数(ANC)≤0.5×10⁹/L、淋巴细胞绝对计数(ALC)≤0.5×10⁹/L或血小板≤25×10⁹/L。 3. 实验室检查异常,包括但不限于以下任一项:血清总胆红素≥1.5 mg/dL;ALT或AST>正常值上限的2.5倍;血清肌酐≥2.0 mg/dL。 4. 纽约心脏病协会(NYHA)Ⅲ或Ⅳ级心力衰竭,或超声心动图左心室射血分数(LVEF)<50%。 5. 肺功能异常,室内空气下血氧饱和度<92%。 6. 入组前12个月内有心肌梗死、心脏血管成形术或支架置入、不稳定型心绞痛或其他临床显著严重心脏病史。 7. 3级高血压,且药物治疗后血压控制不佳。 8. 有颅脑外伤、意识障碍、癫痫、严重脑缺血或脑出血性疾病史。 9. 存在自身免疫性疾病、免疫缺陷或其他需要免疫抑制治疗的情况。 10. 存在未控制的活动性感染。 11. 既往接受过任何CAR-T细胞产品或其他基因修饰T细胞治疗。 12. 入组前4周内接种过活疫苗。 13. HIV、HBV、HCV或TPPA/RPR阳性,或为HBV携带者。 14. 有酒精滥用、药物滥用或精神疾病史。 15. 入组本研究前3个月内参加过任何其他临床研究。 16. 女性受试者符合以下任一情况:目前妊娠或哺乳;计划在研究期间妊娠;或有生育能力但不愿/无法采取有效避孕措施。 17. 研究者判断不适合参加本研究的其他情况。
Inclusion Criteria
Subjects must meet all of the following criteria to be enrolled:
1. Aged 18 to 75 years, regardless of sex;
2. Histologically confirmed relapsed/refractory B-cell lymphoma according to the 2020 World Health Organization (WHO) classification;
3. ECOG performance status of 0-2;
4. Expected survival of at least 3 months;
5. CD20 expression on tumor cells confirmed by flow cytometry and/or immunohistochemistry;
6. Patients who are resistant/refractory to CD19 CAR-T cell therapy or have low CD19 expression;
7. No severe cardiac, pulmonary, hepatic, or renal disease;
8. Able to understand and willing to sign the informed consent form for this study;
9. No contraindications to peripheral blood mononuclear cell collection/apheresis;
10. At least one measurable and evaluable lesion according to RECIST 1.1;
11. Must have previously received standard first-line and second-line therapy;
12. No antibody-based therapy within 2 weeks prior to cell therapy. Exclusion Criteria
Subjects meeting any of the following criteria will be excluded:
1. History of allergy to any component of the cell product;
2. Abnormal complete blood count meeting any of the following: WBC ≤1 × 10⁹/L, ANC ≤0.5 × 10⁹/L, ALC ≤0.5 × 10⁹/L, or PLT ≤25 × 10⁹/L;
3. Laboratory abnormalities including, but not limited to, any of the following: total serum bilirubin ≥1.5 mg/dL; ALT or AST \>2.5 times the upper limit of normal; serum creatinine ≥2.0 mg/dL;
4. New York Heart Association (NYHA) Class III or IV heart failure, or left ventricular ejection fraction (LVEF) \<50% on echocardiography;
5. Abnormal pulmonary function, with oxygen saturation \<92% on room air;
6. History of myocardial infarction, cardiac angioplasty or stenting, unstable angina, or other clinically significant severe cardiac disease within 12 months prior to enrollment;
7. Grade 3 hypertension with poor blood pressure control despite medication;
8. History of craniocerebral trauma, disturbance of consciousness, epilepsy, severe cerebral ischemia, or cerebral hemorrhagic disease;
9. Presence of autoimmune disease, immunodeficiency, or other conditions requiring immunosuppressive therapy;
10. Presence of uncontrolled active infection;
11. Prior treatment with any CAR-T cell product or other genetically modified T-cell therapy;
12. Receipt of a live vaccine within 4 weeks prior to enrollment;
13. Positive for HIV, HBV, HCV, or TPPA/RPR, or HBV carrier status;
14. History of alcohol abuse, drug abuse, or psychiatric illness;
15. Participation in any other clinical study within 3 months prior to enrollment in this study;
16. Female subjects meeting any of the following conditions:
1. currently pregnant or breastfeeding;
2. planning to become pregnant during the study period; or
3. of childbearing potential and unwilling or unable to use effective contraception;
17. Any other condition that, in the investigator's judgment, makes the subject unsuitable for participation in this study.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:TEAEs · Adverse events during treatment · From date of initial treatment to the 30 days after treatment
次要终点:Disease-related clinical responses
1. 研究题目:CD19/CD20 CAR/TRuC-T治疗复发/难治性B细胞淋巴瘤的疗效和安全性研究。 2. 研究目标:主要目标为评估CD19/CD20 CAR/TRuC-T细胞治疗复发/难治性B细胞淋巴瘤患者的安全性;次要目标为评估疗效;探索性目标为评估输注的CD19/CD20 CAR/TRuC-T细胞在体内的扩增和持续存在情况。 3. 受试者干预:计划输注CD19/CD20 CAR/TRuC-T细胞前第-5、-4、-3天,受试者接受淋巴细胞清除化疗(FC方案:氟达拉滨+环磷酰胺)。FC化疗结束72小时后输注CAR/TRuC-T细胞。
1. Study Title: A Study on the Efficacy and safety of CD19/CD20 CAR/TRuC-T in Relapsed/Refractory B-Cell Lymphoma 2. Study Objectives: Primary Objective: To evaluate the safety of CD19/CD20 CAR/TRuC-T cell therapy in patients with relapsed/refractory B-cell lymphoma. Secondary Objective: To evaluate the efficacy of CD19/CD20 CAR/TRuC-T cell therapy in patients with relapsed/refractory B-cell lymphoma. Exploratory Objective: To assess in vivo expansion and persistence of infused CD19/CD20 CAR/TRuC-T cells. 3. Participant Intervention: Participants will receive lymphodepleting chemotherapy (FC regimen: Fludarabine + Cyclophosphamide) on Days -5, -4, and -3 relative to the planned CD19/CD20 CAR/TRuC-T cell infusion. The CAR/TRuC-T cell infusion will be administered 72 hours after the completion of the FC chemotherapy.
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