Dual-Targeted Umbilical Cord Blood CAR-T Cells Against CD19 and CD22 for the Treatment of Relapsed or Refractory Acute B-Cell Lymphoblastic Leukemia
A Single-Center Phase I Clinical Trial of Dual-Targeted Umbilical Cord Blood CAR-T Cells Against CD19 and CD22 for the Treatment of Relapsed or Refractory Acute B-Cell Lymphoblastic Leukemia
This investigator-initiated, prospective, single-arm, phase I dose-escalation trial aims to evaluate the safety and tolerability of anti-CD19/CD22 dual-target cord blood-derived CAR-T cells in adult patients with relapsed/refractory B-cell acute lymphoblastic leukemia who have failed prior therapies, with the goal of reducing antigen-escape relapse and overcoming poor autologous T-cell fitness through the use of universally available umbilical cord blood T cells.
調査の概要
状態
詳細な説明
Patients with relapsed/refractory B-cell acute lymphoblastic leukemia who meet eligibility criteria will receive fludarabine (30 mg/m²/d) and cyclophosphamide (300 mg/m²/d) for three consecutive days as lymphodepleting conditioning, followed by a single intravenous infusion of anti-CD19/CD22 dual-target cord blood-derived CAR-T cells. Dose assignment follows a "3+3" escalation design across three dose levels (4×10⁶, 8×10⁶, and 12×10⁶ CAR-T/kg, ±20%). Dose-limiting toxicity will be assessed during the first 14 days post-infusion to determine the maximum tolerated dose. After CAR-T infusion, patients will be monitored for safety and efficacy at protocol-specified time points through 3 months, with long-term follow-up continuing up to 15 years post-infusion. A total of 18 patients will be enrolled.
研究の種類
入学 (推定)
段階
- フェーズ 1
連絡先と場所
研究連絡先
- 名前：Weiyang Liu
- 電話番号：+86 13817506393
- メール：lwy21758760@sjtu.edu.cn
研究場所
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Shanghai Municipality
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Shanghai、Shanghai Municipality、中国、200025
- 募集
- Ruijin Hospital, Shanghai Jiao Tong University School of Medicine
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コンタクト：
- Jin Wang, PhD
- 電話番号：+86 13524945202
- メール：jinwang@shsmu.edu.cn
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参加基準
適格基準
就学可能な年齢
健康ボランティアの受け入れ
受講資格のある性別
説明
Inclusion Criteria:
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The patient or their legally authorized guardian has signed the informed consent form (ICF), indicating understanding of the purpose and procedures of this clinical trial and willingness to participate.
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Age between 18 and 75 years, male or female.
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Diagnosis of relapsed/refractory B-cell acute lymphoblastic leukemia (R/R B-ALL) according to the Chinese Guidelines for Diagnosis and Treatment of Adult Acute Lymphoblastic Leukemia (2024 edition).
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Leukemic cells confirmed to express CD19 and/or CD22 by flow cytometry.
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ECOG performance status 0-2.
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Life expectancy ≥12 weeks.
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Adequate organ function at screening, meeting all of the following laboratory criteria:
- Hematology: absolute neutrophil count (ANC) ≥1×10⁹/L; absolute lymphocyte count (ALC) ≥0.3×10⁹/L; platelet count ≥20×10⁹/L; hemoglobin ≥60 g/L.
- Hepatic function: ALT and AST ≤2.5× upper limit of normal (ULN); total bilirubin ≤1.5× ULN.
- Renal function: creatinine clearance (CrCl) ≥40 mL/min (by Cockcroft-Gault formula).
- Coagulation: fibrinogen ≥1.0 g/L; activated partial thromboplastin time (APTT) ≤1.5× ULN; prothrombin time (PT) ≤1.5× ULN.
- Oxygen saturation >91%.
- Left ventricular ejection fraction (LVEF) ≥50%.
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The subject and their spouse agree to use effective contraceptive measures (excluding rhythm method) from ICF signing through 1 year after CAR-T cell infusion.
Exclusion Criteria:
- Active graft-versus-host disease (GVHD) or autoimmune disease requiring long-term immunosuppressive therapy.
- Use of therapeutic doses of corticosteroids (defined as prednisone or equivalent >20 mg/day) within 7 days prior to screening. Physiologic replacement, topical, and inhaled steroids are permitted.
- Hypertension not controllable with medication.
- Severe cardiac disease, including but not limited to: unstable angina, myocardial infarction (within 6 months prior to screening), congestive heart failure (NYHA class ≥III), or severe arrhythmia.
- Unstable systemic disease as judged by the investigator, including but not limited to: severe hepatic, renal, or metabolic disease requiring medication.
- Malignancy other than B-ALL within 5 years prior to screening, except for adequately treated carcinoma in situ of the cervix, basal cell or squamous cell skin cancer, localized prostate cancer after radical surgery, or ductal carcinoma in situ of the breast after radical surgery.
- History of solid organ transplantation.
- Planned surgery within 2 weeks after study treatment (subjects scheduled for local anesthesia surgery may participate).
- Receipt of other interventional investigational drugs within 1 month prior to ICF signing.
- Uncontrolled active infection.
- Positive for HBsAg, or positive for HBcAb with detectable HBV DNA in peripheral blood; positive for HCV antibody with detectable HCV RNA; positive for HIV antibody; positive for CMV DNA; positive for syphilis serology.
- Pregnant or breastfeeding women.
- Psychiatric illness, consciousness disorder, or central nervous system disease.
- Other conditions deemed unsuitable for enrollment by the investigator.
研究計画
研究はどのように設計されていますか？
デザインの詳細
- 主な目的：処理
- 割り当て：なし
- 介入モデル：単一グループの割り当て
- マスキング：なし（オープンラベル）
武器と介入
参加者グループ / アーム |
介入・治療 |
|---|---|
|
実験的：Anti-CD19/CD22 Dual-Target Cord Blood CAR-T Cells
A single intravenous infusion of anti-CD19/CD22 dual-target umbilical cord blood-derived CAR-T cells administered on Day 0, following lymphodepleting chemotherapy with fludarabine (30 mg/m²/day) and cyclophosphamide (300 mg/m²/day) for three consecutive days. Dose escalation follows a 3+3 design across three dose levels (4.0×10⁶, 8.0×10⁶, and 12.0×10⁶ CAR-T/kg, ±20%). All subjects receive the same investigational product; no comparator arm is included. |
Genetically modified umbilical cord blood-derived T cells expressing chimeric antigen receptors targeting both CD19 and CD22. Administered as a single intravenous infusion on Day 0 following lymphodepleting chemotherapy. Dose levels: 4.0×10⁶, 8.0×10⁶, and 12.0×10⁶ CAR-T/kg (±20%) according to 3+3 dose escalation design. 30 mg/m² intravenous infusion over 30 minutes once daily for 3 consecutive days as lymphodepleting preconditioning prior to CAR-T cell infusion. 300 mg/m² intravenous infusion over 30 minutes once daily for 3 consecutive days as lymphodepleting preconditioning prior to CAR-T cell infusion. |
この研究は何を測定していますか？
主要な結果の測定
結果測定 |
メジャーの説明 |
時間枠 |
|---|---|---|
|
Incidence and Severity of Dose-Limiting Toxicity (DLT)
時間枠：Within 14 days after CAR-T cell infusion
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DLT is defined as treatment-related adverse events occurring within 14 days post-infusion. Non-hematologic DLT: Grade ≥3 toxicity not reducible to ≤ Grade 1 within 72 hours. Hematologic DLT: Grade 4 toxicity (excluding lymphopenia) persisting >21 days, not attributable to underlying disease. Predefined exclusion criteria include tumor lysis syndrome, electrolyte disturbances, hypogammaglobulinemia, transient laboratory abnormalities, febrile neutropenia, and others per protocol. CRS/ICANS graded per ASTCT 2019, aGVHD per modified Glucksberg, other AEs per CTCAE v5.0. |
Within 14 days after CAR-T cell infusion
|
二次結果の測定
結果測定 |
メジャーの説明 |
時間枠 |
|---|---|---|
|
Objective Response Rate (ORR)
時間枠：1 and 3 months post-infusion
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ORR is the proportion of subjects achieving CR/CRi at 1 and 3 months post-infusion. Efficacy assessed by bone marrow examination per international acute leukemia response criteria. |
1 and 3 months post-infusion
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Minimal Residual Disease (MRD) Negativity Rate
時間枠：1 and 3 months post-infusion
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MRD negativity rate is the proportion of subjects achieving MRD-negative status by flow cytometry at 1 and 3 months post-infusion. |
1 and 3 months post-infusion
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Complete Remission (CR) Rate
時間枠：1 and 3 months post-infusion
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CR rate is the proportion achieving CR. Efficacy assessed by bone marrow examination per international acute leukemia response criteria. |
1 and 3 months post-infusion
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Progression-Free Survival (PFS)
時間枠：From infusion up to 24 months
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PFS is defined as time from infusion to disease progression, relapse, or death. Median PFS and 12-/24-month PFS rates will be estimated by Kaplan-Meier method. |
From infusion up to 24 months
|
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Overall Survival (OS)
時間枠：From infusion up to 24 months
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OS is defined as time from infusion to death from any cause. Median OS and 12-/24-month OS rates will be estimated by Kaplan-Meier method. |
From infusion up to 24 months
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CAR-T Cell Expansion and Persistence
時間枠：Up to 90 days post-infusion
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CAR-T cell levels and vector copy number (VCN) in peripheral blood will be measured. |
Up to 90 days post-infusion
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CAR-T Cell Expansion and Persistence
時間枠：Up to 90 days post-infusion
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PK parameters: Cmax(Peak Plasma Concentration) |
Up to 90 days post-infusion
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CAR-T Cell Expansion and Persistence
時間枠：Up to 90 days post-infusion
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PK parameters: Tmax |
Up to 90 days post-infusion
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CAR-T Cell Expansion and Persistence
時間枠：Up to 90 days post-infusion
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PK parameters: AUC₀-₂₈d, AUC₀-₉₀d. |
Up to 90 days post-infusion
|
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CAR-T Cell Expansion and Persistence
時間枠：At 3 and 6 months
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Proportion of subjects with detectable CAR-T cells at 3 and 6 months, and duration of persistence will be recorded. |
At 3 and 6 months
|
協力者と研究者
スポンサー
研究記録日
主要日程の研究
研究開始 (実際)
一次修了 (推定)
研究の完了 (推定)
試験登録日
最初に提出
QC基準を満たした最初の提出物
最初の投稿 (実際)
学習記録の更新
投稿された最後の更新 (実際)
QC基準を満たした最後の更新が送信されました
最終確認日
詳しくは
本研究に関する用語
追加の関連 MeSH 用語
その他の研究ID番号
- RJ-ALL 2026-B01
医薬品およびデバイス情報、研究文書
米国FDA規制医薬品の研究
米国FDA規制機器製品の研究
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