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Bispecific Antibody-Based Salvage Therapy Followed by CAR-T ± ASCT in R/R Aggressive B-Cell Lymphoma
Bu Faz 2 (Phase 2) çalışma iki ardışık tedavi aşamasından oluşuyor. İlk aşamada nükseden/dirençli agresif B hücreli lenfoma hastaları iki kür glofitamab (araştırmacının seçtiği ajanlarla birlikte veya tek başına) alıyor; ikinci aşamada uygun hastalara FC lenfodeplesyonu sonrası CAR-T infüzyonu, uygun görülenlere ise hazırlık kemoterapisi ve periferik kök hücre geri verilmesinin ardından CAR-T uygulanıyor. CAR-T sonrası 28. günde Deauville 4-5 veya ctDNA pozitifliği saptanan hastalara dört kür glofitamab konsolidasyon tedavisi veriliyor. Çalışmaya DLBCL, yüksek dereceli B hücreli lenfoma veya transforme büyük B hücreli lenfoma tanılı hastalar alınıyor.
Yukarıdaki özet, resmî kaydın sade dile aktarılmış halidir. Orijinal İngilizce başlık referans için gösterilir.
Kriterler ClinicalTrials.gov kaydından orijinal İngilizce haliyle alınmıştır. Uygunluk kararını yalnızca deneyi yürüten ekip verebilir.
Inclusion Criteria:
1. Patients with relapsed/refractory aggressive B-cell lymphoma, including the following subtypes: diffuse large B-cell lymphoma (DLBCL), high-grade B-cell lymphoma (HGBL), or transformed large B-cell lymphoma.
2. Relapsed or refractory disease, meeting criteria for one of the following cohorts:
Cohort 1 (Relapsed/Refractory Disease):
1. ≥2 prior lines of therapy (including both anti-CD20 monoclonal antibody and anthracycline-based chemotherapy) with documented progression following last treatment; OR
2. Failure of first-line immunochemotherapy (containing anti-CD20 antibody and anthracycline) defined by any of:
* Relapse/progression within 12 months of treatment completion; OR
* Progressive disease during first-line therapy; OR
* Stable disease as best response after 4 cycles; OR
* Partial response as best response after 6 cycles.
Cohort 2 (Early Treatment Failure):
* Persistent metabolic activity (Deauville 5) on PET-CT after 2 cycles of first-line immunochemotherapy; OR
* Biopsy-proven residual disease following initial therapy.
3. Age ≥18 years and ≤65 years.
4. Eastern Cooperative Oncology Group (ECOG) performance status ≤2.
5. Hematologic parameters at screening must meet the following (unless due to bone marrow involvement):
* Absolute neutrophil count (ANC) ≥1×10⁹/L,
* Platelet count (PLT) ≥75×10⁹/L.
6. Biochemical parameters at screening must meet the following:
* Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) ≤3× upper limit of normal (ULN);
* Total bilirubin (TBIL) ≤1.5×ULN (unless due to Gilbert's syndrome or non-hepatic causes);
* Serum creatinine (Cr) ≤2×ULN OR creatinine clearance ≥40 mL/min.
7. Left ventricular ejection fraction (LVEF) within institutional normal range by echocardiography.
8. Baseline oxygen saturation \>92% on room air.
9. Life expectancy ≥3 months as assessed by the investigator.
Exclusion Criteria:
1. Confirmed primary central nervous system lymphoma;
2. Prior autologous or allogeneic hematopoietic stem cell transplantation;
3. Active HBV or HCV infection, defined as HBV-DNA or HCV-RNA levels above the upper limit of detection.
4. Uncontrolled comorbidities include infectious diseases, cardiovascular/cerebrovascular disorders, coagulopathies, and connective tissue diseases.
5. History of epilepsy or other central nervous system disorders;
6. Pregnancy or lactation;
7. HIV infection;
8. History of other malignancies unless:
1. Disease-free for ≥5 years, or
2. Previously cured of the following:
* Non-melanoma skin cancers (basal cell carcinoma, squamous cell carcinoma, or related localized cutaneous malignancies)
* Carcinoma in situ of cervix
9. Other conditions deemed ineligible by investigators.