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:CD19/CD22 CAR-T Consolidation in R/R Aggressive B-Cell Lymphoma After Second-Line Therapy
这是一项 II 期注册临床试验,评估 CD19 免疫治疗用于淋巴瘤的安全性、可行性及初步疗效。当前状态:招募中。计划入组 30 例。试验地点:中国 · 北京(共 1 个中心,其中中国 1 个)。登记号:NCT07779018。
不限性别 · ≥ 18 Years 且 ≤ 85 Years
纳入标准: • 患者同意并签署知情同意书,愿意且能够遵守计划访视、研究治疗、实验室检查及其他研究程序。 • 按2016年WHO标准,经细胞学或组织学确诊CD19和/或CD22阳性大B细胞淋巴瘤(LBCL),包括弥漫大B细胞淋巴瘤(DLBCL)、高级别B细胞淋巴瘤(HGBL)等;接受标准二线化疗方案诱导治疗后达到完全缓解(CR),且自CR起不超过3个月。 • 存在以下至少一项可能的高危因素:FISH证实双打击或三打击高级别B细胞淋巴瘤,伴MYC和BCL2和/或BCL6重排;伴11q异常的晚期B细胞淋巴瘤/伯基特样淋巴瘤;初诊时国际预后指数(IPI)2–5分、年龄校正IPI(aaIPI)2–3分,或美国NCCN-IPI 4–8分;免疫组化CD5阳性;免疫组化提示MYC和BCL-2双表达(建议阈值:MYC≥40%、BCL2≥50%);基因测序发现TP53突变;或二代测序(NGS)提示MCD亚型或N1亚型。 • 年龄18至85岁,男女不限。 • ECOG体能状态评分0–2分。 • 自签署知情同意书之日起预期生存期>3个月。 • 血红蛋白≥60 g/L。 • 外周血中性粒细胞绝对值≥1,000/µL,血小板计数≥45,000/µL。 • 肝、肾、心肺功能符合以下要求:总胆红素(TBIL)≤正常值上限(ULN)的1.5倍(Gilbert综合征患者除外);ALT和AST≤ULN的2.5倍;血清肌酐≤ULN的1.5倍或按Cockcroft-Gault公式估算的肌酐清除率(CCr)≥60 mL/min;左心室射血分数(LVEF)≥50%,超声心动图未见心包积液或具有临床意义的心律失常;室内空气下经皮基线血氧饱和度>92%;无具有临床意义的胸腔积液。 • 有妊娠计划者须同意从入组前至研究结束持续采取避孕措施,共至少6个月。如已妊娠或疑似妊娠,应立即告知研究者。 • 不适合接受造血干细胞移植(HSCT)或拒绝接受HSCT。 排除标准: • 既往接受任何形式的CAR细胞治疗或其他基因修饰T细胞治疗。 • 对氨基糖苷类抗生素或其他必需药物有严重即刻型超敏反应史。 • 已知HIV感染、活动性乙肝病毒(HBV)感染,或存在需要静脉抗生素治疗的未控制活动性全身感染。活动性HBV感染定义为以下三项同时满足:HBV DNA定量≥2,000 IU/mL;ALT≥正常值上限的2倍;并排除由疾病本身、药物或其他原因引起的肝炎。初诊时有活动性HBV感染、经抗HBV治疗后转为非活动性感染者,在抗病毒治疗充分的前提下可入组。 • 非血液系统肿瘤(如淋巴瘤)相关肝肾功能障碍:ALT>ULN的3倍、AST>ULN的3倍、TBIL>ULN的2倍,或血清肌酐清除率<30 mL/min。 • 入组前12个月内有心肌梗死、心脏血管成形术或冠状动脉支架置入术、不稳定型心绞痛、活动性心律失常或其他具有临床意义的心血管疾病。 • 存在可能影响本研究的其他严重疾病,如糖尿病、胃溃疡、其他严重呼吸或循环系统疾病、严重自身免疫病或先天性免疫缺陷、严重且无法有效控制的感染,以及其他病情变化风险高的疾病。 • 对本研究必须使用的任何药物有严重即刻型超敏反应史;或对生物制品(包括抗生素)有严重过敏史。 • 妊娠或哺乳期女性(预处理化疗方案可能对胎儿或婴儿造成风险)。 • 研究者判定受试者不能按方案完成所有要求的访视或诊断程序(包括中长期随访),参与意愿差、不愿参加或全面遵守研究安排,或受试者及其家属依从性不足。是否符合要求由研究者决定。 • 既往患有其他恶性肿瘤者不得入组,除非已无疾病且至少3年未接受任何形式的抗肿瘤治疗;非黑色素瘤皮肤癌以及宫颈、膀胱、乳腺等部位的原位癌除外。 • 预处理方案开始前6周内接种过活疫苗。 • 过去14天内接受过大型手术(淋巴结活检除外),或预计治疗期间需接受大型手术。 • 存在可能增加参加研究风险、干扰研究结果的其他严重躯体或精神疾病或实验室异常,或研究者认为不适合参加本研究的其他情况。
Inclusion Criteria: * 1\. With the patient's consent and signed informed consent form, willing and able to comply with the planned visits, research treatments, laboratory tests, and other experimental procedures; 2. CD19 and/or CD22-positive large B-cell lymphoma (LBCL) diagnosed by cytology or histology according to WHO 2016 criteria, including diffuse large B-cell lymphoma (DLBCL), high-grade B-cell lymphoma (HGBL), etc., whose disease has achieved complete response (CR) after induction treatment with a standard second-line chemotherapy regimen and who are within 3 months from the time of CR. 3\. The possible high-risk factors for the patient's onset of the disease are as follows: 1) FISH confirmed high-grade B-cell lymphoma with double or triple strikes, accompanied by MYC and BCL2 and/or BCL6 rearrangements; 2) Advanced B-cell lymphoma with 11q abnormalities/Burkitt like lymphoma with 11q abnormalities; 3) The International Prognostic Index (IPI) at the time of initial diagnosis is 2-5 points; The Age Adjusted International Prognostic Index (aaIPI) is 2-3 points; The National Comprehensive Cancer Network International Prognostic Index (NCCN-IPI) score ranges from 4-8 points in the United States; 4) Immunohistochemical CD5 positivity; 5) Immunohistochemistry suggests dual expression of MYC and BCL-2 (recommended dual expression threshold is MYC ≥ 40%, BCL2 ≥ 50%); 6) Gene sequencing shows TP53 mutation; 7) The second-generation sequencing (NGS) suggests molecular typing as MCD subtype and N1 subtype; 4. Age range from 18 to 85 years old, male or female; 5. Subjects with physical fitness status scores ranging from 0 to 2 in the Eastern Cooperative Oncology Group (ECOG) in the United States; 6. Expected survival period from the date of signing the informed consent form is greater than 3 months; 7. HGB ≥ 60g/L; 8. The absolute value of neutrophils in peripheral blood is ≥ 1000/μl, and the platelet count is ≥ 45000/μl; 9. Liver and kidney function, as well as heart and lung function, meet the following requirements: 1) Total bilirubin (TBIL) ≤ 1.5 times the upper limits of normal (ULN), except for subjects with Gilbert's syndrome; 2) Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) ≤ 2.5 times ULN; 3) Serum Creatinine (Cr) ≤ 1.5 times ULN or Creatinine Clearance Rate (CCr) ≥ 60mL/min, estimated based on the Cockcroft Gault formula; 4) The left ventricular ejection fraction (LVEF) of the heart is ≥ 50%. Echocardiography (ECHO) confirms no pericardial effusion and no clinically significant arrhythmia; 5) Baseline transcutaneous oxygen saturation under indoor ventilation\>92%; 6) No clinically significant pleural effusion; 10. Participants with pregnancy plans must agree to take contraceptive measures for a continuous period of 6 months from before enrollment in the study until the end of the study; If the subject is pregnant or suspected of being pregnant, the researcher should be notified immediately. 11.Patients who are not eligible for hematopoietic stem cell transplantation (HSCT) or who refuse HSCT. Exclusion Criteria: * 1\. Have received any form of chimeric antigen receptor cell therapy or other genetically modified T cell therapy; 2. Has a history of severe immediate hypersensitivity reactions to aminoglycoside antibiotics and other essential medications; 3. Known history of human immunodeficiency virus (HIV) infection or active hepatitis B virus (HBV) infection, or any uncontrolled active systemic infection requiring intravenous antibiotics (active HBV infection is defined as: a. HBV DNA quantification ≥ 2000 IU/ml; b. ALT ≥ 2 times the normal upper limit value; c. Exclude hepatitis caused by the disease itself, medication, or other reasons; All three conditions must be met simultaneously. If a patient is diagnosed with active HBV infection at the time of initial diagnosis and becomes non active HBV infection after anti HBV treatment, they can be included in this study under the premise of sufficient anti HBV treatment; 4. Non hematological tumors (such as lymphoma) associated liver and kidney dysfunction: ALT\>3 times the upper limit of normal, AST\>3 times the upper limit of normal, TBIL\>2 times the upper limit of normal, serum creatinine clearance rate\<30 mL/min; 5. History of myocardial infarction, cardiac angioplasty or coronary stent implantation, unstable angina, active arrhythmia, or other clinically significant cardiovascular diseases within the 12 months prior to enrollment; 6. Other serious medical diseases may have an impact on this study (such as diabetes, gastric ulcer, other serious respiratory and circulatory diseases, severe autoimmune diseases or congenital immune defects, severe infection and inability to be effectively controlled), as well as other diseases with high risk of disease change; 7. Has a history of severe immediate hypersensitivity reactions to any medication necessary for use in this study; History of severe allergy to biological products (including antibiotics); 8. Female subjects who are currently pregnant or breastfeeding (with potential risks to the fetus or infant from pre-treatment chemotherapy regimens); 9. The researchers determined that the subjects were unable to complete all the required visit surveys or diagnostic procedures (including medium - and long-term follow-up visits) as per the study protocol, had poor willingness to participate in the study, were unwilling to join and fully comply with the study arrangements, and had insufficient compliance with the study by the subjects and their families. The decision-making power belongs to the researcher; 10. The subjects who have previously suffered from other malignant tumors cannot be included in this study unless they are disease-free and have not received any form of anti-tumor treatment for at least 3 years (except for skin tumors of non malignant melanoma and in situ cancers occurring in the cervix, bladder, breast, etc.); 11. History of receiving live vaccines within 6 weeks prior to initiating the pre-treatment plan; 12. Those who have undergone large-scale surgical treatment (excluding lymph node biopsy) within the past 14 days, or those who are expected to undergo large-scale surgical treatment during the treatment process; 13. There are other serious physical or mental illnesses or laboratory abnormalities that may increase the risk of participating in the study, or interfere with the study results, as well as patients deemed unsuitable by the researchers to participate 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:1-year progression free survival rate (1-year-PFSR) · The 1-year progression-free survival rate (1-year PFSR) is defined as the proportion of patients who are alive and progression-free at 1 year after CAR-T cell infusion. · 1 year after treatment
次要终点:overall survival (OS);progression free survival (PFS);time to progression (TTP);disease free survival (DFS);event free survival (EFS);Relapse Rate;Incidence and Severity of Treatment-Emergent Adverse Events
接受CD19/CD22靶向CAR-T细胞免疫治疗。
本研究旨在评估CD22/CD19靶向嵌合抗原受体T细胞(CAR-T)免疫治疗作为二线治疗后巩固治疗,用于高危侵袭性B细胞淋巴瘤患者的疗效和安全性。
The purpose of this study is to determine the efficacy and safety of CD22/CD19-targeted CAR-T cell immunotherapy as consolidation therapy after second-line treatment in patients with high-risk aggressive B-cell lymphoma.
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