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:CAR-T in Relapsed/Refractory Multiple Myeloma
这是一项 II 期注册临床试验,评估 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:招募中。计划入组 10 例。试验地点:其他 · 拉瓦尔品第(共 2 个中心)。登记号:NCT07689058。
不限性别 · ≥ 18 Years
纳入标准: 1. 年龄≥18岁,男女均可。 2. 按国际骨髓瘤工作组(IMWG)诊断标准确诊多发性骨髓瘤。 3. 既往至少接受3线MM治疗,或对免疫调节剂(IMiD)和蛋白酶体抑制剂(PI)均耐药(按IMWG共识标准定义)。注:是否接受造血干细胞移植及维持治疗均不影响将诱导治疗计为一线治疗。 4. 筛查时依据IMWG标准存在可测量疾病。 5. ECOG体能状态评分0–2分。 6. 器官功能充分:中性粒细胞/血小板达到方案阈值(MM所致细胞减少除外),LVEF≥45%,氧合充分,肝肾功能符合方案第10节标准。 7. 有生育能力女性妊娠试验阴性;同意采取有效避孕措施。 8. 充分理解研究方案的影响和限制后,书面同意参加研究。 9. 理解知情同意书(ICF)内容并自愿签署;因不识字无法自行签署者须有公正见证人在场。 10. 能理解研究流程,愿意且能够遵守所有研究方案和其他要求。 11. 愿意且能够遵守本方案规定的禁令和限制。 排除标准: 1. 既往接受任何靶点的CAR-T治疗,或任何BCMA靶向治疗。 2. 已知当前或既往存在中枢神经系统(CNS)受累,或有多发性骨髓瘤脑膜受累的临床表现。 3. 签署ICF前6个月内发生卒中或癫痫发作。 4. 未控制的活动性感染,包括未控制的细菌/真菌感染或活动性未控制HBV/HCV/HIV感染。 5. 临床显著心脏病(如NYHA III/IV级、近期心肌梗死)或严重肺部疾病。 6. 近期接受异基因HSCT,且有活动性GVHD或正在接受免疫抑制治疗。 7. 妊娠、哺乳,或计划在研究期间及接受研究治疗后1年内妊娠。 8. 其他可能影响参与者在研究中心接受或耐受计划治疗、理解知情同意的情况,或研究者认为不符合参与者最佳利益(如损害其健康)或可能妨碍、限制或混淆方案评估的任何状况。
Inclusion Criteria 1. Male and female participants of age 18 years and above. 2. Patients with a confirmed diagnosis of multiple myeloma according to IMWG diagnostic criteria. 3. Received at least 3 prior multiple myeloma treatment lines of therapy or are double refractory to an IMiD and PI (refractory multiple myeloma as defined by IMWG consensus criteria). Note: induction with or without hematopoietic stem cell transplant and with or without maintenance therapy is considered a single line of therapy. 4. Measurable disease at Screening as per IMWG criteria. 5. ECOG Performance Status grade of 0 to 2. 6. Adequate organ function: ANC/platelets thresholds (unless cytopenias attributable to MM), LVEF ≥45%, adequate oxygenation; hepatic/renal criteria specified in Section 10. 7. Negative pregnancy test for women of childbearing potential; agreement to effective contraception. 8. Patients giving written informed consent to participate in the study after a full understanding of the implications and constraints of the study protocol. 9. Understand the content of the ICF, and voluntarily sign the ICF (If the participant is unable to sign the ICF on their own due to illiteracy, an impartial witness is needed). 10. The subject can understand the research process and is willing and able to comply with all research proposals and other requirements of the study. 11. Willing and able to adhere to the prohibitions and restrictions specified in this protocol. Exclusion Criteria 1\. Patients who will meet any of the following criteria will not be eligible to participate in the study. 1. Prior treatment with CAR-T therapy directed at any target. Any therapy that is targeted to BCMA. 2. Known active, or prior history of central nervous system (CNS) involvement, or exhibits clinical signs of meningeal involvement of multiple myeloma. 3. Stroke or seizure within 6 months of signing the ICF. 4. Uncontrolled active infection, including uncontrolled bacterial or fungal infection; active uncontrolled HBV/HCV/HIV. 5. Clinically significant cardiac disease (e.g., NYHA III/IV, recent MI), or severe pulmonary disease. 6. Recent allogeneic HSCT with active GVHD or ongoing immunosuppression. 7. Pregnant or breast-feeding, or planning to become pregnant while enrolled in this study or within 1 year after receiving study treatment. 8. Any other circumstances that would impair the ability of the participant to receive or tolerate the planned treatment at the investigational site, to understand informed consent, or any condition for which, in the opinion of the investigator, participation would not be in the best interest of the participant (e.g., compromise the well-being) or that could prevent, limit, or confound the protocol-specified assessments. \- Exclusion Criteria: \-
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:Assess Safety /tolerability and feasibility of manufacturing and delivering the product · incidence/severity of AEs including CRS/ICANS (ASTCT grading), DLTs through Day +28 · From enrolment to 1 years after infusion of the product
筛查阶段:所有参与者须提供书面同意,并在单采前28天内进行资格筛查。单采前须满足的安全标准见第8.1.1节。若某项评估属于参与者常规临床评估而非专为本研究开展,且符合研究要求并在首次研究治疗给药前规定时限内完成,则签署知情同意后无需重复。仅允许在筛查阶段对导致排除的异常筛查值复测一次以重新评估资格;以单采前最后一次结果确定资格。未满足全部纳入标准或符合排除标准者可由研究者酌情处理(登记原文此处截断)。
多发性骨髓瘤的治疗近年来显著进步,为患者提供了多种可根据个体情况选择的疗法。治疗选择取决于疾病侵袭性、遗传标志等预后指标、患者总体身体状况及可能影响治疗的既往健康问题。现有策略包括作用机制不同的多类药物:蛋白酶体抑制剂(PI)可干扰骨髓瘤细胞的蛋白质降解过程并促进细胞死亡;免疫调节药物(IMiD)调节免疫系统并增强机体天然抗癌反应以抑制肿瘤生长;单克隆抗体可特异性靶向癌细胞并标记其供免疫系统清除。对于符合条件的患者,自体干细胞移植仍是一种可行选择,可用患者自身健康干细胞替换受损骨髓,争取长期缓解。尽管治疗取得进展,多发性骨髓瘤仍面临重大挑战:初始治疗成功后疾病常会复发,且目前仍属不可治愈疾病。因此亟需创新疗法克服现有治疗耐药,改善患者结局和生存。
The treatment options for multiple myeloma have evolved significantly over the years, providing patients with a range of therapies tailored to their specific circumstances. The choice of treatment often hinges on various factors, including the aggressiveness of the disease, individual prognostic indicators like genetic markers, the overall physical condition of the patient, and any pre-existing health issues that may affect treatment decisions. Current therapeutic strategies include several classes of drugs, each working through different mechanisms. Proteasome inhibitors (PIs) disrupt the protein degradation process within myeloma cells, thereby promoting their death. Immunomodulatory drugs (IMiDs) modulate the immune system and inhibit tumor growth by enhancing the body's natural anti-cancer responses. Monoclonal antibodies specifically target cancer cells, marking them for destruction by the immune system. In cases where patients are eligible, autologous stem cell transplantation remains a viable option, offering the potential for long-term remission by replacing damaged bone marrow with healthy stem cells from the patient's own body. Despite these advancements, multiple myeloma continues to present significant challenges, as it often recurs even after initial successful treatment and remains an incurable disease. This highlights the urgent need for innovative therapeutic strategies that can effectively address resistance to existing treatments, ultimately aiming to improve patient outcomes and survival rates.
MEMBER ACCOUNT
登录成功会直接打开下一页。