CAR-T Cells Combined With Peptide Specific Dendritic Cell in Relapsed/Refractory Leukemia/MDS

A Clinical Study of Chimeric Antigen Receptor T Cells Combined With Eps8 Peptide Specific Dendritic Cell for Patients With Relapsed/Refractory Leukemia and Myelodysplastic Syndromes

The main purpose of this study is to verify the safety and potential effectiveness of CART cells combined with peptide specific dendritic cell in relapsed/refractory leukemia.

A prospective study to evaluate the safety and efficacy of Chimeric antigen receptor T cells combined with Eps8 or WT1（Wilms tumor 1） peptide specific dendritic cell for patients with relapsed/refractory leukemia. There are options for CAR-targets: CD19, CD20, CD22 and CD10 for acute lymphoblastic leukemia; CD33, CD38 CD56, CD117, CD123, CD34 and Muc1 for acute myeloid leukemia and Myelodysplastic Syndrome. Progression free survival, overall Survival, overall response rate, and duration of response were monitored.

Inclusion Criteria:

1. Tumor type: Acute Myeloid Leukemia (AML) and Acute Lymphoblastic Leukemia (ALL) according to the WHO criteria (at least 20% blasts in the marrow). All FAB subtypes except M3. Patients with Myelodysplastic Syndrome, category of Refractory Anemia with Excess Blasts (RAEB): RAEB I (WHO: medullary blast count ≤ 10% and a peripheral blast count ≤ 5%) and RAEB II (WHO: medullary blast count > 10% and/or > 5% peripheral blasts) can be included in the study in absence of other non-experimental treatment modalities.

2. Positive antigen for any of CD19, CD20, CD22, CD10, CD33, CD38, CD56, CD117, CD123, CD34, or Muc1.Simultaneously ,high expression of EPS8 or WT1 in acute leukemia.

3. Relapsed/Refractory leukemia 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 CAR-T cell infusion.

4. Age greater than 18 year and less than 80 years.

5. Objectively assessable parameters of life expectancy: more than 3 months.

6. Performance status: WHO PS grade 0-1 (ECOG performance status 0 or 1).

7. Meet the following criteria for apheresis：WBC >= 3,000/L, Hb >= 8.0 g/dL, platelet count >= 80,000/mm3, <= 600,000/mm3.

8. Pulmonary function: Peripheral blood oxygen saturation greater than 90%; Cardiac function: Left ventricular ejection fraction >60%.

9. Prior and concomitant associated diseases allowed with the exception of underlying autoimmune disease and positive serology for HIV/HBV/HCV.

10. No concomitant use of immunosuppressive drugs.

11. Adequate renal and liver function, i.e. creatinin, bilirubin, and aminotransferase =< 1.2 times the upper limit of normal.

12. Absence of any psychological, familial, sociological or geographical condition potentially hampering compliance with the study protocol and follow-up schedule; those conditions should be discussed with the patient before registration in the trial.

13. Women of child-bearing potential should use adequate contraception prior to study entry and for the duration of study participation.

14. Written informed consent obtained.

Exclusion Criteria:

1. Patients with severe complications: cardiovascular disorders, respiratory disorders, renal dysfunction, immunodeficiency, hematological disorders, autoimmune diseases, sever allergy and severe infectious disease.
2. Patients who should receive systemic administration of steroid or immunosuppressive agents.
3. Presence of active brain metastases.
4. Pregnant, lactating, or possibly pregnant women, or willing to be pregnant.
5. Severe psychiatric disorder.
6. Active multiple cancers.
7. Patients have received other genetic therapy products.
8. Transfection efficiency was less than 30%.
9. Inappropriate for study entry judged by an attending physician.
10. patients who have sensitivity to drugs that provide local anesthesia.