To observe the safety and efficacy of Nanobody-Based CD5-targeted chimeric antigen receptor T cells in the treatment of refractory or relapsed T-ALL/LBL.
This Phase I/II study aims to evaluate the safety, tolerability, and efficacy of Nanobody-Based CD5 Chimeric Antigen Receptor (CAR) T-cell therapy in patients with relapsed or refractory (R/R) T-cell acute lymphoblastic leukemia (T-ALL) or T-cell lymphoblastic lymphoma (T-LBL). In the Phase I portion, a 3+3 dose-escalation design will be utilized to assess the safety profile and determine the optimal dose of Nanobody-Based CD5 CAR-T cells. The recommended Phase II dose (RP2D) will be established based on safety data, dose-limiting toxicities (DLTs), and preliminary efficacy outcomes. The Phase II portion will then evaluate the efficacy of Nanobody-Based CD5 CAR-T therapy at the RP2D. The primary and secondary endpoints will include: Overall response rate (ORR) Disease-free survival (DFS) Overall survival (OS) Comprehensive safety assessments will be conducted throughout the study, with a particular focus on cytokine release syndrome (CRS) and immune effector cell-associated neurotoxicity syndrome (ICANS). By investigating Nanobody-Based CD5 CAR-T therapy, this study aims to address the significant unmet clinical need for effective treatment options in patients with R/R T-ALL/LBL and provide insights into its potential as a novel immunotherapeutic approach.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
30
Phase I: Eligible patients will receive a single infusion of CD5-targeted CAR-T cells at one of three dose levels (0.5 × 10⁶ cells/kg, 1.0 × 10⁶ cells/kg, or 2.0 × 10⁶ cells/kg) following fludarabine and cyclophosphamide (FC) lymphodepleting chemotherapy. A 3+3 dose-escalation design will be used to determine the recommended Phase II dose (RP2D) based on safety, dose-limiting toxicities (DLTs), and preliminary efficacy. Phase II: Patients will receive CD5-targeted CAR-T cells at the RP2D following FC lymphodepleting chemotherapy.
Peking University People's Hospital
Beijing, Beijing Municipality, China
RECRUITINGDLT (Dose-Limiting Toxicity)
CRS and ICANS will be assessed per ASTCT (2019), while other AEs follow CTCAE v5.0. DLTs are CAR-T-related AEs that occur within 28 days post-infusion and meet the following criteria: Grade 4+ CRS, or Grade 3 CRS unresolved to ≤ Grade 2 within 7 days. Grade 3+ non-hematologic toxicity unresolved to ≤ Grade 2 within 7 days. Grade 4+ ICANS, or Grade 3 ICANS unresolved to ≤ Grade 2 within 3 days. Grade 3+ hypersensitivity reaction. Any unexpected toxicity requiring study discontinuation. Exemptions: Rapid hypersensitivity resolving to ≤ Grade 2 in 2 hours. Reversible Grade 3 AEs lasting ≤7 days. Transient CRS-related organ dysfunction, resolving in ≤7 days per SRC. All DLTs are reviewed by the Safety Review Committee (SRC).
Time frame: Day28 after CAR-T cell infusion
Overall Response Rate (ORR)
ORR is defined as the proportion of patients achieving Complete Remission (CR), Complete Remission with Incomplete Hematologic Recovery (CRi), or Morphologic Leukemia-Free State (MLFS) per European LeukemiaNet (ELN) 2022 for T-ALL and Lugano/Lyric 2016 for T-LBL. CR: \<5% blasts in bone marrow, no circulating blasts/extramedullary disease, ANC \>1.0 × 10⁹/L, platelets \>100 × 10⁹/L, MRD-negative. CRi: Meets CR but lacks full hematologic recovery. MLFS: \<5% blasts, no hematologic recovery required. Lugano 2016 (T-LBL): CR = complete metabolic response on PET-CT; PR = ≥50% tumor reduction.
Time frame: Within 3 months after CAR-T cell infusion
Progression-Free Survival (PFS)
Progression-Free Survival (PFS) is defined as the time from the date of first documented Complete Remission (CR), Complete Remission with Incomplete Hematologic Recovery (CRi), or Morphologic Leukemia-Free State (MLFS) until the date of bone marrow (BM) or peripheral blood (PB) relapse, extramedullary disease (EMD) progression, or death from any cause, whichever occurs first. PFS will be assessed according to European LeukemiaNet (ELN) 2022 criteria for T-ALL and Lugano/Lyric 2016 criteria for T-LBL.
Time frame: Within 2-year after CAR-T cell infusion
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Overall Survival (OS)
Overall Survival (OS) is defined as the time from the date of CD5-targeted CAR-T cell infusion until death from any cause. Patients alive at the time of analysis will be censored at the date of last follow-up.
Time frame: Within 2-year after CAR-T cell infusion