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:Exploratory Clinical Trial of DQ1001 in Relapsed or Refractory Multiple Myeloma (RRMM)
这是一项 I 期注册临床试验,评估通用型 CAR-T 细胞治疗多发性骨髓瘤的安全性、可行性及初步疗效。当前状态:尚未开始招募。计划入组 16 例。登记号:NCT07622862。
不限性别 · ≥ 18 Years 且 ≤ 70 Years
纳入标准: • 在任何研究程序前自愿签署知情同意书。 • 签署知情同意书时年龄18–70岁(含)。 • 按IMWG标准确诊复发/难治性多发性骨髓瘤,既往至少接受过3线治疗;最近一线治疗期间或完成后2个月内有记录的疾病进展,或最近一线治疗后2个月内未达到至少微小缓解(MR)。 • 骨髓或外周血肿瘤细胞经流式细胞术检测BCMA/GPRC5D阳性,或肿瘤组织经免疫组化检测BCMA/GPRC5D阳性。 • 筛选时有可测量疾病,符合以下至少一项:IgG型血清单克隆M蛋白≥10 g/L;IgA、IgD、IgE或IgM型血清M蛋白≥5 g/L;24小时尿M蛋白≥200 mg;轻链型骨髓瘤受累血清游离轻链(FLC)≥100 mg/L且血清κ/λ FLC比值异常(<0.26或>1.65)。 • ECOG体能状态0–2,预期生存期≥12周。 • 有生育能力男性及女性同意自签署知情同意书起至末次研究药物给药后2年采取有效避孕措施。有生育能力女性包括绝经前女性及绝经后2年内女性;筛选时须血清妊娠试验阴性。 • 既往接受造血干细胞移植者无活动性GVHD,且已停止全身免疫抑制剂至少4周。 • 主要器官功能充分:ANC≥1.0×10⁹/L、血红蛋白≥70 g/L、血小板≥50×10⁹/L、淋巴细胞>0.2×10⁹/L;纤维蛋白原≥1.0 g/L、APTT≤1.5×ULN、PT≤1.5×ULN;总胆红素≤2×ULN(Gilbert综合征患者≤3×ULN),AST/ALT≤3×ULN;LVEF≥50%;无需补充氧气时外周血氧饱和度≥92%,或吸氧时≥95%;按CKD-EPI公式估算eGFR≥30 mL/min/1.73m²。 • 研究者判断受试者能够遵守方案并完成治疗和随访。 排除标准: • 中枢神经系统(CNS)转移、软脑膜疾病或CNS转移性压迫;或既往有CNS疾病史,包括但不限于癫痫、偏瘫、失语、中风、重型脑外伤、痴呆或帕金森病。 • 既往接受CAR-T治疗或靶向BCMA/GPRC5D的药物治疗。 • 签署知情同意书前4周内有活动性或中重度慢性GVHD,或首次输注前4周内接受全身GVHD治疗。 • 首次输注前28天内接受任何研究药物或全身抗肿瘤治疗;研究者可根据药物半衰期决定采用28天或5个半衰期(取更适当者)。 • 签署知情同意前28天内接受大范围放疗;若针对非靶病灶进行局部姑息性放疗,且在签署同意前14天内完成或计划研究期间进行,可允许。 • 签署知情同意前28天内接受重大手术,或研究期间计划重大手术。 • 筛选时HBsAg阳性;或HBsAg阴性但HBcAb阳性且外周血可检出HBV DNA;HCV抗体阳性且HCV RNA阳性;HIV抗体阳性;CMV DNA阳性;梅毒螺旋体和非梅毒螺旋体抗体均阳性。 • 已知对研究药物任何成分过敏,包括但不限于淋巴清除药物(如托珠单抗、环磷酰胺、氟达拉滨)或影像检查所用造影剂。 • 严重呼吸系统疾病(包括严重/极重度COPD或间质性肺病);或有显著心血管病史,包括签署知情同意前6个月内接受冠状动脉旁路移植或经皮冠状动脉介入、心肌梗死、NYHAⅢ–Ⅳ级心衰、不稳定型心绞痛、QTcF>480 ms、本人或家族有长/短QT综合征、需药物治疗的未控制严重心律失常或高血压。 • 研究者判断可能影响遵守方案或不适合参加的合并症/其他情况。 • 妊娠或哺乳,计划妊娠,或不愿在研究期间及治疗结束后2年内采用高效可靠避孕。 • 未控制的活动性感染(上述病毒感染除外),包括研究者认为会增加研究治疗风险的严重细菌、真菌或其他病毒感染。 • 签署知情同意前1个月内接种减毒活病毒疫苗。 • 免疫缺陷病史或活动性自身免疫病;入组时病情稳定且≥6个月未需全身免疫抑制治疗的自身免疫病患者除外。 • 筛选前2年内确诊多发性骨髓瘤以外的其他恶性肿瘤;根治治疗后入组前≥2年无活动性疾病者、充分治疗且无疾病证据的非黑色素瘤皮肤癌,或根治治疗的原位癌除外。
Inclusion Criteria:
1. Voluntary signing of the Informed Consent Form (ICF) prior to undergoing any study-related procedures.
2. Age at the time of ICF signing is between 18 and 70 years inclusive.
3. Diagnosis of relapsed or refractory multiple myeloma (MM), per IMWG criteria:
* Prior receipt of at least three lines of therapy;
* Documented progressive disease (PD) during the most recent therapy or within two months after its completion, or documented failure to achieve at least minimal response (MR) within two months after the most recent therapy.
4. Tumor cells in bone marrow or peripheral blood are BCMA/GPRC5D-positive by flow cytometry; or tumor tissue is BCMA/GPRC5D-positive by immunohistochemistry.
5. Presence of measurable disease at screening, defined as any one of the following:
* For IgG-type MM: serum monoclonal M-protein ≥10 g/L; for IgA-, IgD-, IgE-, or IgM-type MM: serum monoclonal M-protein ≥5 g/L; or
* Urinary M-protein ≥200 mg/24 h; or
* Light-chain MM: involved serum free light chain (FLC) ≥100 mg/L and abnormal serum FLC κ/λ ratio (\<0.26 or \>1.65).
6. ECOG performance status score of 0-2.
7. Expected survival ≥12 weeks.
8. Men with reproductive potential and women of childbearing potential must agree to use effective contraception from the time of ICF signing through two years after the last dose of study drug. Women of childbearing potential include premenopausal women and women within two years of menopause. A negative serum pregnancy test is required at screening for women of childbearing potential.
9. For patients who previously underwent hematopoietic stem cell transplantation: no active graft-versus-host disease (GVHD), and systemic immunosuppressants discontinued for at least four weeks.
10. Adequate major organ function, defined as follows:
* Hematologic: absolute neutrophil count (ANC) ≥1.0 × 10⁹/L; hemoglobin ≥70 g/L; platelet count ≥50 × 10⁹/L; lymphocyte count \>0.2 × 10⁹/L;
* Coagulation: fibrinogen ≥1.0 g/L; activated partial thromboplastin time (APTT) ≤1.5 × upper limit of normal (ULN); prothrombin time (PT) ≤1.5 × ULN;
* Hepatic: total bilirubin ≤2 × ULN (≤3 × ULN in patients with Gilbert syndrome); aspartate aminotransferase (AST) ≤3 × ULN; alanine aminotransferase (ALT) ≤3 × ULN;
* Cardiopulmonary: left ventricular ejection fraction ≥50%; peripheral capillary oxygen saturation ≥92% without supplemental oxygen, or ≥95% with supplemental oxygen;
* Renal: estimated glomerular filtration rate (eGFR) ≥30 mL/min/1.73 m² (calculated using the CKD-EPI equation).
11. Investigator judgment that the participant is able to comply with protocol requirements and complete treatment and follow-up.
Exclusion Criteria:
1. Central nervous system (CNS) metastases, leptomeningeal disease, or metastatic CNS compression; or a prior history of CNS disorders, including but not limited to epilepsy, hemiplegia, aphasia, stroke, severe traumatic brain injury, dementia, or Parkinson's disease.
2. Prior treatment with CAR-T therapy or drugs targeting BCMA or GPRC5D.
3. Active or moderate-to-severe chronic graft-versus-host disease (GVHD) within four weeks prior to signing the informed consent form (ICF), or systemic GVHD-directed therapy within four weeks before the first infusion.
4. Any investigational drug or systemic antitumor therapy administered within 28 days (or five half-lives of the drug, whichever is deemed more appropriate by the investigator) prior to the first infusion.
5. Extensive radiotherapy administered within 28 days prior to signing the ICF; localized palliative radiotherapy to non-target lesions is permitted if administered within 14 days prior to signing the ICF or anticipated during the study period.
6. Major surgical procedure performed within 28 days prior to signing the ICF, or planned major surgery during the study period.
7. Positive hepatitis B surface antigen (HBsAg) at screening; or negative HBsAg but positive hepatitis B core antibody (HBcAb) with detectable hepatitis B virus (HBV) DNA in peripheral blood; positive hepatitis C virus (HCV) antibody and HCV RNA; positive human immunodeficiency virus (HIV) antibody; positive cytomegalovirus (CMV) DNA; or positive for both treponemal and non-treponemal antibodies for syphilis.
8. Known hypersensitivity to any component of the study drugs, including but not limited to lymphodepleting agents (e.g., tocilizumab, cyclophosphamide, fludarabine) or contrast agents used for imaging studies.
9. Severe respiratory disease (including but not limited to severe or very severe chronic obstructive pulmonary disease, interstitial lung disease); or significant cardiovascular history (including but not limited to coronary artery bypass grafting or percutaneous coronary intervention within six months prior to signing the ICF, myocardial infarction, New York Heart Association \[NYHA\] Class III-IV congestive heart failure, unstable angina, corrected QT interval (QTcF) \> 480 ms, personal or familial history of long or short QT syndrome, uncontrolled severe arrhythmia or hypertension requiring pharmacologic management).
10. Any comorbidity or other condition judged by the investigator to potentially compromise adherence to the study protocol or render the participant unsuitable for participation in this study.
11. Pregnant or lactating women, or women planning pregnancy or unwilling to use highly effective, reliable contraception during the study and for two years following completion of study treatment.
12. Uncontrolled active infection (excluding those viral infections listed above), including but not limited to serious bacterial, fungal, or other viral infections deemed by the investigator to increase the risk associated with study treatment.
13. Receipt of a live attenuated viral vaccine within one month prior to signing the ICF.
14. History of immunodeficiency disorder or active autoimmune disease (patients with stable autoimmune disease at enrollment who have not required systemic immunosuppressive therapy for ≥6 months are exempted).
15. Diagnosis of any malignancy other than multiple myeloma within the past two years prior to screening, except for: malignancies treated with curative intent and without evidence of active disease for ≥2 years prior to enrollment; adequately treated non-melanoma skin cancer with no current evidence of disease; or carcinoma in situ treated with curative intent.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:Number of Participants with Dose-limiting Toxicity (DLT) · DLT refers to drug-related toxicities that occur during treatment, the severity of which is clinically unacceptable, thereby restricting further dose escalation.
All adverse events are assessed and graded by the investigator according to the NCI-CTCAE version 6.0. Cytokine release syndrome (CRS) and immune effector cell-associated neurotoxicity syndrome (ICANS) are graded per the ASTCT criteria, and acute graft-versus-host disease (aGVHD) per the MAGIC criteria. · Within 28 days after the infusion of DQ1001;Number of Participants with Adverse Events (AEs) by Severity · An adverse event is any untoward medical occurrence in a clinical study participant that does not necessarily have a causal relationship with the pharmaceutical/biological agent under study. Severity will be graded according to the National Cancer Institute Common Terminology Criteria for Adverse Events (NCI-CTCAE) version 6.0. Cytokine release syndrome (CRS) and immune effector cell-associated neurotoxicity syndrome (ICANS) are graded per the ASTCT criteria, and acute graft-versus-host disease (aGVHD) per the MAGIC criteria. · Up to 2 years;Establish recommended Phase 2 dose (RP2D) · Up to 2 years
次要终点:efficacy endpoint: Overall response rate (ORR);efficacy endpoint: Duration of Response (DoR);efficacy endpoint: MRD negativity rate;efficacy endpoint: Time to response (TTR);efficacy endpoint: progression-free survival (PFS);Efficacy endpoint: Overall survival (OS);Concentration of CAR-T cells after Infusion (PK);Lymphocyte Subsets and Concentration of Cytokine after Infusion (PD)
本前瞻性、单臂、开放标签早期探索性研究旨在评估DQ1001细胞制剂治疗复发/难治性多发性骨髓瘤患者的安全性、耐受性和疗效。所有受试者接受DQ1001静脉输注。研究包括剂量递增和剂量扩展两个阶段;确定剂量递增阶段的最佳剂量后,将该剂量队列扩展至总计12例(包括剂量递增阶段入组者),以进一步评估DQ1001的安全性、耐受性和疗效。
This is a prospective, single-arm, open-label, early exploratory clinical study designed to evaluate the safety, tolerability, and efficacy of the DQ1001 cell product in patients with relapsed or refractory multiple myeloma. All participants will receive intravenous infusions of DQ1001. The study consists of two phases: dose escalation and dose expansion. Following identification of an optimal dose during the dose-escalation phase, the cohort receiving that dose will be expanded to include a total of 12 participants-including those enrolled during dose escalation-to further assess the safety, tolerability, and efficacy of DQ1001.
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