Sequential Treatment With CD20/CD22/CD10-CART After CD19-CART Treatment Base on MRD in Relapsed/Refractory B-ALL

Study Overview
=================
Brief Summary
-----------------
CD19-negative B-ALL relapses after CD19 CAR T-cell treatment have occurred in some patients. CD20/CD22/CD10 is still expressed in CD19 negative B-ALL cells which means these CD molecules may become new targets in treatment of CD19-negative relapse of B-ALL. Thus sequential treatment with CD20/CD22/CD10-CART after CD19-CART treatment in relapsed/refractory B-ALL will kill and eliminate CD19 negative B-ALL cells and prolong the remission time.

Detailed Description
-----------------
B-cell acute lymphoblastic leukemia is the most common type of leukemia and the prognosis of relapsed/refractory B-ALL is poor. Chimeric Antigen Receptor-transduced T cell (CAR-T) therapy is one of revolutionary targeted immunotherapy. CD19 CAR-T is the most commonly used engineered T cell in B-ALL. The treatment effect is significant and far more than traditional therapy in relapsed/refractory B-ALL. However, the remission time after CD19 CAR-T infusion is short.CD19-positive and CD19-negative B-ALL relapses after CD19 CAR T-cell treatment have occurred in some patients The cause of relapse after CAR-T infusion is minimal residual disease (MRD) which will induce CD19 negative relapse. CD20/CD22/CD10 is still expressed in CD19 negative B-ALL cells which means these CD molecules may become new targets in treatment of CD19 negative relapse of B-ALL. Thus sequential treatment with CD20/CD22/CD10-CART after CD19-CART treatment in relapsed/refractory B-ALL will kill and eliminate CD19 negative B-ALL cells and prolong the remission time.

Official Title
-----------------
Sequential Treatment With CD20/CD22/CD10-CART After CD19-CART Treatment Base on MRD in Relapsed/Refractory B-ALL

Conditions
-----------------
Therapy Related Leukemia

Intervention / Treatment
-----------------
* Biological: Sequential Treatment With different CART


Participation Criteria
=================
Eligibility Criteria
-----------------
Inclusion Criteria: Relapsed/Refractory B-ALL patients Did not achieve complete remission after 2 times of standard plan chemotherapy Relapsed after first induction chemotherapy Did not response to chemotherapy before HSCT or relapsed after HSCT Cannot receive allo-HSCT or refuse to receive allo-HSCT Relapsed after CD19-CART infusion MRD monitoring confirmed positive(MRD>0.01%) after CD19-CART infusion Cell phenotype is CD19 negative and CD20/CD22/CD10 positive (single or combined) after CD19-CART therapy Estimated survival time is more than 3 months in leukemia Volunteered for this clinical trail and signed a consent form Exclusion Criteria: MRD was negative after CD19-CART therapy MRD was negative while the cell phenotype was CD19 expressed Patients with severe insufficient cardiac, pulmonary and hepatorenal functions Patients with severe mental illness, neurological disease or infectious disease Patients with GVHD was taking immunosuppressants Pregnant or lactating women Patients have received other genetic therapy products Transfection efficiency was less than 30% Any situation may do harm to the subjects or interfere the results

Ages Eligible for Study
-----------------
Minimum Age: 18 Years
Maximum Age: 60 Years

Sexes Eligible for Study
-----------------
All

Accepts Healthy Volunteers
-----------------
No

Study Plan
=================
How is the study designed?
-----------------

Design Details

Primary Purpose: Treatment
Intervention Model: Sequential Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Sequential therapy with different CART<br>Sequential therapy With different CART including one kind of CD20/CD22/CD10-CART After CD19-CART therapy in CD19-negative relapse ALL patients, subjects will receive 1-5 x 10^6/Kg transduced CAR T cells at one time. | Biological: Sequential Treatment With different CART<br>* Sequential Treatment With CD20/CD22/CD10-CART After CD19-CART Treatment in Relapsed/Refractory B-ALL<br>|

What is the study measuring?
-----------------
Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Adverse events that Are related to treatment | Determine the toxicity profile of the CD19-targeted and CD20/CD22/CD10-targeted CAR-T cells with Common Toxicity Criteria for Adverse Effects (CTCAE) version 4.0. | 2 years | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Estimate 2 year overall survival(OS) after infusion of CD19-CART and sequential treatment | To estimate 2 year overall survival(OS) after CD19-CART infusion and sequential treatment with Relapsed/Refractory B-ALL | 2 years | 
| Estimate relapse rate after infusion of CD19-CART and sequential treatment | To estimate relapse rate after CD19-CART infusion and sequential treatment with Relapsed/Refractory B-ALL | 4 years | 
| Estimate 2 year progression free survival after infusion of CD19-CART and sequential treatment | To estimate 2 year progression free survival (PFS) after CD19-CART infusion and sequential treatment with Relapsed/Refractory B-ALL | 2 years | 

 Terms related to the study
=================
Keywords Provided by Centre Hospitalier Valida
-----------------
CD19-CART, CD20-CART, CD10-CART, CD22-CART, Relapsed/Refractory B-ALL, MRD