Allogeneic hematopoietic stem cell transplantation (allo-HSCT), a process in which hematopoietic stem cells from a donor are injected into the recipient's body, are the treatment of choice for many hematologic malignancies. Graft-versus-host disease (GVHD) is a common and important complication after allogeneic HSCT. GVHD is a major obstacle to the success of HSCT treatment and a leading cause of death after HSCT treatment. Hormone therapy is currently the standard treatment for aGVHD, i.e., the first-line treatment. However, 40%\~50% of aGVHD cannot be controlled by hormone therapy, and additional therapeutic intervention is required. According to the National Comprehensive Cancer Network (NCCN) clinical practice guidelines for hematopoietic stem cell transplantation - pre-transplant recipient evaluation and management of GVHD (2021.V3), the recommended drugs for second-line treatment of grade II\~IV aGVHD include: alemtuzumab, α-1 antitrypsin, antithymocyte globulin, basiliximab, calcineurin inhibitors, etanercept, extracorporeal photopheresis replacement therapy, infliximab, mammalian rapamycin target protein inhibitors, mycophenolate mofetil, Pentostatin, ruxolitinib, tocilizumab. Second-line treatment is based on retrospective data and there is no standard salvage therapy, which is reflected in the inconsistent treatment strategy for aGVHD across transplant centers. One of the biological functions of hAESCs in amniotic membranes in vivo is to exert reproductive immunomodulatory effects and protect the fetus from rejection by the maternal immune system, so hAESCs have natural immunomodulatory functions. hAESCs have significant inhibitory effects on T cells, antigen-presenting cells (APCs), natural killer (NK) cells, macrophages, neutrophils, B cells and other immune cells associated with organ damage during the pathogenesis of aGVHD, and hAESCs have great potential in the treatment of aGVHD. Therefore, the sponsor developed hAESCs injections intended for the treatment of aGVHD. The experimental drug in this study is hAESCs injection, which is intended to be used for the treatment of adult patients with grade III.\~IV. refractory aGVHD after hematopoietic stem cell transplantation, and to explore the safety and preliminary efficacy of its treatment.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
18
The dose escalation is carried out according to the "3+3" ascending principle, and a total of 3 dose levels are set: 1. Dose Level 1: 1×106 cells/kg; 2. Dose Level 2: 2×106 cells/kg; 3. Dose Level 3: 3×106 cells/kg; Note: In this study, if the maximum tolerated dose (MTD) is not explored at dose level 3 (3×106 cells/kg), it will be discussed by the Safety Review Committee (SRC) to decide whether to proceed with further dose escalation or expansion to 6 patients.
Number of Subjects with DLT at a Given Dose Level
Number of Subjects with DLT at a Given Dose Level(Low/Medium/High). A dose limiting toxicity (DLT) is defined as the hAESCs-related adverse event (AE) greater level than 3(including grade 3) that occurs during the DLT period, graded according to the NCI Common Terminology Criteria for Adverse Events (CTCAE), Version 5.0.
Time frame: 28 days
Maximum Tolerated Dose (MTD)
The Maximum Tolerated Dose (MTD) of hAESCs. The MTD is defined as the previous lower dose in the dose group in which ≥ 2/6 subjects developed DLT during the DLT observation period after infusion of hAESCs injection.
Time frame: 28 days
Incidence of adverse events
Incidence of adverse events (AEs), serious adverse events (SAEs), adverse events of special interest (AESIs).
Time frame: 100 days
Overall response rate (ORR)
Overall response rate (ORR) after hAESCs injection infusion. ORR rate: the proportion of the total number of subjects who obtained CR, VGPR or PR after receiving study treatment to the total number of evaluable subjects.
Time frame: 100 days
Complete response (CR) rate
Complete response rate after hAESCs injection infusion. CR rate: the proportion of the total number of subjects who received a CR after receiving treatment to the total number of evaluable subjects.
Time frame: 100 days
Very good partial response (VGPR) rate
Very good partial response (VGPR) rate after hAESCs injection. VGPR rate: the proportion of the total number of subjects who received VGPR after receiving treatment to the total number of evaluable subjects.
Time frame: 100 days
Treatment ineffective rate
Treatment ineffective rate after hAESCs injection. Treatment ineffective rate: the proportion of the total number of participants who received NR or PD after receiving treatment to the total number of evaluable subjects.
Time frame: 100 days
Overall survival (OS)
Overall survival (OS) after infusion of hAESCs injection. OS: It refers to the time which begins at the start of treatment and up to the time of death.
Time frame: 2 years
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