Overall Introduction This single-arm, open-label clinical trial aims to evaluate the safety, tolerability, pharmacokinetics, and pharmacodynamics of CXCR4-enabled CCR9 chimeric antigen receptor T-cell injection (CXCR4 CCR9 CAR-T) in patients with relapsed or refractory T-lymphoblastic leukemia/lymphoma (r/r T-ALL/LBL). Additionally, the study seeks to preliminarily assess the efficacy of CXCR4 CCR9 CAR-T cells and explore the appropriate dosage and administration schedule for subsequent Phase II clinical trials. A dose escalation study following the 3+3 design was implemented across three dose cohorts, with each cohort planned to enroll 3 to 6 patients, totaling 9 to 18 participants. Following cell infusion, subjects underwent safety and efficacy follow-up, which continued until 2 years post-infusion, subject withdrawal, or study termination-whichever occurred first. For subjects with available follow-up information after study completion or early termination, long-term follow-up-including long-term safety monitoring-was conducted for up to 15 years.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
12
CXCR4-enabled CCR9 chimeric antigen receptor T-cell injection solution
The First Affiliated Hospital of Soochow University
Suzhou, Jiangsu, China
RECRUITINGDose-limiting toxicity (DLT)
DLT refers to any of the following conditions occurring within 28 days after cell reinfusion that are related to cell infusion: ① Hematologic DLT: Grade 4 toxicity (excluding lymphopenia) not caused by the underlying disease and taking more than 30 days to resolve to ≤ Grade 2. ② Non-hematologic DLT: Any toxicity ≥ Grade 4 that is possibly related to CAR-T therapy, or Grade 3 toxicity that requires ≥7 days to resolve to ≤ Grade 2 or to return to baseline.
Time frame: Within 28 days after CXCR4 CCR9 CAR-T cell infusion
Adverse Event (AE)
Record the types, occurrence frequency and severity of adverse events (AEs) related to CAR-T, with specific definitions determined according to CTCAE v5.0.The CRS and ICANS ratings do not use CTCAE but adopt the evaluation criteria in the ASTCT standards.
Time frame: 2 years
The Recommended Phase II Dose(RP2D)
The dose recommended for use in phase 2 studies on the basis of dose limiting toxicities observed in phase 1 studies.
Time frame: Within 28 days after CXCR4 CCR9 CAR-T cell infusion
Objective Response Rate (ORR)
Defined as the proportion of subjects achieving an objective response (complete or partial response). All subjects not meeting the objective response criteria as of the data cutoff date will be considered non-responders. ①For T-ALL patients: Treatment response is defined as the achievement of either Complete Remission (CR) or Complete Remission with Incomplete Hematologic Recovery (CRi); ②For T-LBL patients: Treatment response is defined as the achievement of either Complete Response (CR) or Partial Response (PR);
Time frame: 28 days and within 3 months after infusion of CXCR4 CCR9 CAR-T cells
MRD-negative rate (for T-ALL)
The proportion of T-ALL patients with negative MRD in the bone marrow when the therapeutic effect reaches remission. T-ALL patients have residual leukemia cells in the bone marrow detected by flow cytometry below 10-⁴ and/or negative qualitative or quantitative detection of bone marrow fusion genes (if any).
Time frame: 28 days and within 3 months after infusion of CXCR4 CCR9 CAR-T cells
Duration of Response (DOR)
It refers to the period from the time when the subject first achieves remission to the time of disease progression or death due to the disease. Subjects who have not experienced disease progression or death by the time of the final data collection will be censored at the time of their last valid tumor assessment. Common reasons for censoring include, but are not limited to: * Loss to follow-up; ②Withdrawal from the study; ③Initiation of a new anticancer therapy.
Time frame: 2 years
Progression-Free Survival (PFS)
Defined as the time from the date of cell infusion to the date of first documented disease progression or death from any cause, whichever occurs first. Subjects who have not experienced disease progression or death by the data cutoff date will be censored at the time of their last tumor assessment.
Time frame: 2 years
Event-Free Survival (EFS)
Defined as the time from the date of cell infusion to the occurrence of any of the following events (whichever comes first): * Death from any cause after achieving remission ②Disease relapse or progression ③Treatment failure, defined as either lack of efficacy or discontinuation of the clinical trial due to: * Death * Adverse events * Lack of efficacy or disease progression * Initiation of new antitumor therapy
Time frame: 2 years
Overall Survival (OS)
Defined as the time from the date of cell infusion to the date of death from any cause. For subjects who are still alive at the time of analysis, OS will be censored on the date of last known contact. It is specifically noted that subsequent allogeneic hematopoietic stem cell transplantation or receipt of any new antitumor therapy will not constitute a censoring event for OS analysis.
Time frame: 2 years
Pharmacokinetics-AUC(0-28)
The area under the curve from 0 to 28 days for the reinfusion.
Time frame: 2 years
Pharmacokinetics-Cmax
The peak concentration of the drug in the peripheral blood sample.
Time frame: 2 years
Pharmacokinetics-Tmax
The time at which the peak concentration of the drug is reached in the peripheral blood sample.
Time frame: 2 years
IL-6
Changes in the levels of IL-6.
Time frame: Within 28 days after CXCR4 CCR9 CAR-T cell infusion
IFNγ
Changes in the levels of IFNγ.
Time frame: Within 28 days after CXCR4 CCR9 CAR-T cell infusion
Ferritin
Changes in the levels of Ferritin.
Time frame: Within 28 days after CXCR4 CCR9 CAR-T cell infusion
C-reactive protein(CRP)
Changes in the levels of CRP.
Time frame: Within 28 days after CXCR4 CCR9 CAR-T cell infusion
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