4SCAR-T Therapy Post CD19-targeted Immunotherapy
4SCAR-T Therapy Post CD19-targeted Immunotherapy
This study will evaluate safety and efficacy of a combination of 4th generation chimeric
 antigen receptor gene-modified T cells (4SCAR-T) targeting CD19-negative B-ALL that express
 alternative surface antigens such as CD22, CD10, CD20, CD38, and CD123, as many patients
 relapse after anti-CD19 immunotherapy. Clinical response and optiminzation of a standardized
 lentiviral vector and cell production protocol will be investigated. This is a phase I/II
 trial enrolling patients from multiple clinical centers.
Anti-CD19 immunotherapy based on antibody conjugated drugs or CD19-CAR-T cells has
 demonstrated unprecedented positive response in relapsing/refractory B-cell acute
 lymphoblastic leukemia (r/r B-ALL). However, many patients still relapse and up to 30-50% of
 those relapses are characterized by the loss of CD19 surface antigen. Patients with
 CD19-negative relapse usually have a poor prognosis. The mechanisms underlying CD19-negative
 relapses are not fully understood and it is important to develop solutions to supplement
 post-CD19 immunotherapies.

 Potential markers for recurrent leukemic blasts in an emerging CD19-negative blast population
 include many known B-cell lineage antigens. To prevent further target escape and improve the
 therapeutic effects, the 4th generation CAR gene-modified T cells targeting CD22, CD10, CD20,
 CD38, or CD123 have been considered in post anti-CD19 treatment. This study aims to evaluate
 safety and efficacy of administrating one or multiple non-CD19 targeting CAR-T cells to
 patients with CD19-escaped B cell malignancies.
Inclusion Criteria:

 1. Age older than 6 months.

 2. B cell malignancies relapsed after anti-CD19 immunotherapy.

 3. Malignant B cells expressing one or more of the following surface molecules:
 CD22/CD123/CD38/CD10/CD20.

 4. The KPS score over 80 points, and survival time is more than 1 month.

 5. Greater than Hgb 80 g/L.

 6. No contraindications to blood cell collection.

 Exclusion Criteria:

 1. Complications with other active diseases, and difficult to assess patient response.

 2. Bacterial, fungal, or viral infection unable to control.

 3. Living with HIV.

 4. Active HBV and HCV infection.

 5. Pregnant and nursing mothers.

 6. Under systemic steroid use within a week of the treatment.

 7. Judged difficult to cooporate for continued evaluation.