sequential infusion of anti-cd19 and anti-cd20 car-t cells against relapsed and refractory b-cell lymphoma

Conditions: Recurrent or Refractory B Cell Malignancy

Summary: cluster of differentiation antigen 19(cd19) specifically presents in b lymphocyte cell lines steadily,while not in most normal tissue,including pluripotent hematopoietic stem cells.cluster of differentiation antigen 20(cd20) presents in 90% of b-cell lymphomas.cd19 antigen is a well-established target for b-cell lymphomas treatment as well as cd20 antigen.both cd19-targeting car t cells and cd20-targeting car t cells can be used as adoptive cellular immunotherapies for b-cell lymphomas.though two kinds of single target treatments were proved can induce recession of b-cell lymphomas, the risk of cancer cells to escape and tumor recurrence are still existed. there are no report about combination transfer of two kinds of single target treatments.this research aimed emphasis on safety and therapeutic efficacy evaluation,as well as if combination transfer can decrease recurrence rate.

to determine: primary outcome measure: the overall complete remission rate and one-year survival rate of combination transfer of cd19-targeting car t cells and cd20-targeting car t cells is superior to or at least not worse than two kinds of single target treatments in the treatment of cd19+/cd20+ b-cell lymphomas. the risk of cancer recurrence in a year of combination transfer of cd19-targeting car t cells and cd20-targeting car t cells is inferior to two kinds of single target treatments. secondary outcome measures: evaluate the initial effect time, time to disease progression, and life quality improvement of combination transfer compare to single target treatments. evaluate the safety and tolerability of combination transfer compare to single target treatments by observation of high fever duration in patients and testing related cell factor level in peripheral blood.

Eligibility criteria:
inclusion criteria: * 18 years to 70 years, male and female * survival time\>12 weeks * b cell lymphomas diagnosed by physical examination,pathological examination,laboratory tests and imaging tests * chemotherapy failure or recurrent b cell lymphomas * creatinine\< 2.5mg/dl * glutamic-pyruvic transaminase, glutamic oxalacetic transaminase\< 3 fold of normal level * bilirubin\<2.0mg/dl * karnofsky performance status\>50% at the time of screening * adequate pulmonary, renal, hepatic, and cardiac function * fail in autologous or allogenic haemopoietic stem cell transplantation * free of leukocytes removal contraindications * voluntarily join car-t clinical trial * understand and sign written informed consent exclusion criteria: * pregnant or nursing women or women with pregnancy plan in half a year * any infectious disease (hiv, active tuberculosis, ect.) * active hepatitis b, active hepatitis c infection * feasibility assessment proves that the efficiency of transduction of lymphocyte is below 10% or the lymphocyte amplification is below 5 fold with the costimulation of cluster of differentiation 3(cd 3)and cluster of differentiation 8(cd 8) * abnormal vital signs or cannot cooperate with the inspectors * mental or psychological disease cannot cooperate with treatment and curative effect evaluation * highly allergic constitution or history of severe allergies, especially allergy to interleukin-2(il-2) * general infection or local severe infection, or other infection that is not controlled * dysfunction in lung, heart, kidney and brain * severe autoimmune diseases * other symptoms that are not applicable for car-t