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-CAR.p40-T in Patients With Relapsed/Refractory CD19-Positive Hematologic Malignancies
这是一项 I/II 期注册临床试验,评估 CAR-T 细胞治疗 B 细胞淋巴瘤、急性淋巴细胞白血病、急性髓系白血病的安全性、可行性及初步疗效。当前状态:招募中。计划入组 10 例。试验地点:中国 · 深圳(共 1 个中心,其中中国 1 个)。登记号:NCT07584889。
不限性别 · ≥ 18 Years 且 ≤ 75 Years
纳入标准(须全部符合): 1. 年龄18–75岁,男女均可; 2. 按2022年世界卫生组织(WHO)诊断标准,经组织学或细胞学确诊复发/难治性CD19阳性血液系统恶性肿瘤; 3. ECOG体能状态评分0–2分; 4. 预期生存期至少3个月; 5. 无外周血白细胞单采禁忌证; 6. 流式细胞术和/或免疫组化证实肿瘤细胞表达CD19; 7. 无严重心、肺、肝或肾功能障碍; 8. 能够理解并愿意提供书面知情同意。 排除标准(符合任一项者排除): 1. 对细胞产品任何成分过敏; 2. 血常规符合以下任一项:白细胞≤1×10⁹/L、中性粒细胞绝对计数≤0.5×10⁹/L、淋巴细胞绝对计数≤0.5×10⁹/L或血小板≤25×10⁹/L; 3. 实验室异常,包括但不限于:血清总胆红素≥1.5 mg/dL;ALT或AST>正常值上限2.5倍;或血清肌酐≥2.0 mg/dL; 4. 按纽约心脏协会(NYHA)心功能分级为III或IV级心功能不全,或超声心动图LVEF<50%; 5. 肺功能异常,室内空气下氧饱和度<92%; 6. 入组前12个月内有心肌梗死、心脏血管成形术或支架植入、不稳定型心绞痛或其他有临床意义的严重心脏病史; 7. 3级高血压且药物治疗后血压仍控制不佳; 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. 自身免疫性疾病、免疫缺陷,或其他需要免疫抑制剂治疗的情况; 10. 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检测阳性,或为HBV携带者; 14. 有酗酒、药物滥用或精神疾病史; 15. 入组前3个月内参加过其他临床研究; 16. 女性受试者符合以下任一情况:妊娠或哺乳;计划在研究期间妊娠;有生育能力但不愿或不能采取有效避孕措施; 17. 研究者认为不适合参加研究的其他情况。
Inclusion Criteria
Subjects must meet all of the following criteria to be enrolled:
1. • Aged 18 to 75 years, male or female;
2. • Histologically or cytologically diagnosed with relapsed/refractory CD19-positive hematologic malignancy according to the 2022 World Health Organization (WHO) diagnostic criteria;
3. • Eastern Cooperative Oncology Group (ECOG) performance status of 0-2;
4. • Life expectancy of at least 3 months;
5. • No contraindications to peripheral blood leukapheresis;
6. • CD19 expression on tumor cells confirmed by flow cytometry and/or immunohistochemistry;
7. • No severe cardiac, pulmonary, hepatic, or renal dysfunction;
8. • Able to understand and willing to provide written informed consent. Exclusion Criteria
Subjects who meet any of the following criteria should be excluded from enrollment:
1. History of allergy to any component of the cellular product;
2. Complete blood count meeting any of the following criteria: white blood cell count (WBC) ≤1 × 10⁹/L, absolute neutrophil count (ANC) ≤0.5 × 10⁹/L, absolute lymphocyte count (ALC) ≤0.5 × 10⁹/L, or platelet count (PLT) ≤25 × 10⁹/L;
3. Laboratory abnormalities including, but not limited to, serum total bilirubin ≥1.5 mg/dL; serum alanine aminotransferase (ALT) or aspartate aminotransferase (AST) \>2.5 times the upper limit of normal; or serum creatinine ≥2.0 mg/dL;
4. Class III or IV cardiac insufficiency according to the New York Heart Association (NYHA) functional classification, or left ventricular ejection fraction (LVEF) \<50% by echocardiography;
5. Abnormal pulmonary function, with oxygen saturation \<92% on room air;
6. History of myocardial infarction, cardiac angioplasty or stent placement, 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 traumatic brain injury, disturbance of consciousness, epilepsy, severe cerebral ischemia, or cerebral hemorrhagic disease;
9. Autoimmune disease, immunodeficiency, or other conditions requiring treatment with immunosuppressive agents;
10. 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 test results 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 clinical study;
16. Female subjects who meet any of the following conditions:
1. Pregnant or breastfeeding;
2. Planning to become pregnant during the study; or
3. Of childbearing potential and unwilling or unable to use effective contraception;
17. Any other condition that, in the investigator's opinion, 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 · Treatment-emergent adverse events will be evaluated and graded according to the National Cancer Institute Common Terminology Criteria for Adverse Events (NCI CTCAE) version 5.0 · From date of initial treatment to the 30 days after treatment
次要终点:Disease-related clinical responses
在计划CD19-CAR.p40-T细胞输注前第-5、-4和-3天接受淋巴清除化疗(FC方案:氟达拉滨+环磷酰胺)。FC化疗结束72小时后输注CD19-CAR.p40-T细胞。
1. 研究题目:自分泌表达p40的CD19靶向嵌合抗原受体T细胞(CD19-CAR.p40-T)治疗复发/难治性CD19阳性血液系统恶性肿瘤的疗效和安全性研究。 2. 研究目标: 2.1.1 主要目标:评估自分泌表达p40的CD19靶向CAR-T细胞治疗复发/难治性CD19阳性血液系统恶性肿瘤患者的安全性。 2.1.2 次要目标:评估该疗法的有效性。 2.1.3 探索性目标:评估CD19-CAR.p40-T细胞在体内的扩增和持续存在情况。 3. 受试者干预:在计划输注CD19-CAR.p40-T细胞前第-5、-4和-3天接受淋巴清除化疗(FC方案:氟达拉滨+环磷酰胺)。FC化疗结束72小时后输注CD19-CAR.p40-T细胞。
1. Study Title: A Study on the Efficacy and safety of Autocrine p40-Expressing CD19-Targeted Chimeric Antigen Receptor T Cells (CD19-CAR.p40-T) in Patients With Relapsed/Refractory CD19-Positive Hematologic Malignancies 2. Study Objectives: 2.1.1 Primary Objective To evaluate the safety of autocrine p40-expressing CD19-targeted chimeric antigen receptor T cells (CD19-CAR.p40-T) in the treatment of patients with relapsed/refractory CD19-positive hematologic malignancies. 2.1.2 Secondary Objective To evaluate the efficacy of autocrine p40-expressing CD19-targeted chimeric antigen receptor T cells (CD19-CAR.p40-T) in the treatment of patients with relapsed/refractory CD19-positive hematologic malignancies. 2.1.3 Exploratory Objective To evaluate the in vivo expansion and persistence of CD19-CAR.p40-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-CAR.p40-T cell infusion. The CD19-CAR.p40-T cell infusion will be administered 72 hours after the completion of the FC chemotherapy.
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