This is an investigator-initiated trial aimed at assessing the safety and efficacy of anti-CD19 CAR-T cells in the treatment of childhood-onset refractory ANCA-Associated Vasculitis.
The anti-neutrophil cytoplasmic antibody (ANCA) associated vasculitis (AAV )is one of the most devastating and potentially fatal autoimmune diseases, characterized by involvement of small blood vessels (arterioles, tiny arteries, tiny static veins, and capillaries) and the presence of ANCA. The disease lead to extensive damage in multiple organs and systems,such as pulmonary hemorrhage and rapidly progressive glomerulonephritis (RPGN),ultimately resulting in disability and even death.Children with AAV are particularly at risk of organ damage, especially to the kidneys, and tend to more serious than that in adults. Currently, the primary treatment for AAV relies on glucocorticoids and immunosuppressants to alleviate symptoms. However, due to the absence of a curative treatment, patients often require lifelong medication. In recent years, biological agents such as rituximab have been introduced for the treatment of AAV, but still cannot completely eliminate autoimmune B cells in the bone marrow, leading to unsatisfactory overall outcomes. Furthermore, stopping the drugs can lead to relapse, and there is still no cure for AAV, leaving patients facing the challenges of lifelong medication and an incurable disease. Since 2019, CAR-T cell therapy has been successfully applied to autoimmune diseases. Clinical studies have demonstrated that targeted CD19 CAR-T cells hold significant therapeutic potential for SLE. These cells effectively slow down the pathological progression of SLE and can also effectively treat severe cases. Furthermore, targeted CD19 CAR-T cells are also expected to restore the immune system in SLE patients, potentially allowing them to discontinue lifelong medication and avoid serious long-term side effects of drugs like hormones and immunosuppressants. Studies have reported that CAR-T has a good therapeutic effect on a variety of autoimmune diseases such as systemic sclerosis and idiopathic inflammatory dermatomyositis.The purpose of this study is to assess the safety and efficacy of the anti-CD19 CAR-T cells in the treatment of childhood-onset refractory AAV.
Study Type
OBSERVATIONAL
Enrollment
12
Intravenous injection
Children's Hospital, Zhejiang University School of Medicine
Hangzhou, Zhejiang, China
RECRUITINGThe safety of CAR-T cell in refractory childhood-onset ANCA-Associated Vasculitis
The number of occurrence and proportion of adverse events and serious adverse events that occurred
Time frame: 3 months and 6 months
The efficiency of CAR-T cell in refractory childhood-onset AAV
Percentage of patients achieving 50% response 100% response by the 3-month time
Time frame: 3 months and 6 months
The efficiency of CAR-T cell in refractory childhood-onset AAV
the assessment of disease activity using PVAS/BVAS 3.0 ,the asseeement of the Irreversible damage by PVDI/VDI,and the changes in laboratory values
Time frame: 3 months
Cellular kinetics
CAR transgene levels by quantitative polymerase chain reaction (qPCR) in peripheral blood.
Time frame: 6 months
Autoantibody detection
Autoantibody detection up after CD19 CAR-T cells infusion.
Time frame: 24 months
Duration of disease response (DOR)
the time between the first investigator assessment of remission and the first investigator assessment of progression or death from any cause
Time frame: 24 months
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