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This study is a single-arm, open-label, dose-escalation clinical trial to evaluate the safety, tolerability, changes and persistence of peripheral blood Treg cells, and pharmacodynamic characteristics of donor-derived Treg cell injection combined with recombinant human interleukin-2 in treating subjects with refractory cGVHD,and to preliminarily observe the efficacy of the study drugs in subjects with refractory cGVHD.
This study is a single-arm, open-label, dose-escalation clinical trial to evaluate the safety, tolerability, changes and persistence of peripheral blood Treg cells, and pharmacodynamic characteristics of donor-derived Treg cell injection combined with recombinant human interleukin-2 in treating subjects with refractory cGVHD,and to preliminarily observe the efficacy of the study drugs in subjects with refractory cGVHD.In this study, rapid titration of the first dose group and a "3+3" rule design were used for dose escalation to minimize patient exposure to ineffective doses while minimizing the occurrence of risk.Three dose groups were set up: 1×10^6 Treg cells /kg dose group, 5.0×10^6 Treg cells /kg dose group and 10×10^6Treg cells /kg dose group.One infusion per dose group.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Donor-derived Treg cell injection combined with interleukin 2 | Experimental | Donor-derived Treg cell injection, injections, The first dose was 1.0× 10^6Treg cells /kg, the second dose was 5.0×10^6Treg cells /kg, and the third dose was 10.0×10^6Treg cells /kg,single-dose. Interleukin 2,1 million IU/m2/d,last 13 weeks. |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Donor-derived Treg cell injection combined with interleukin 2 | Biological | Subjects received Treg cell infusion at day D0, and interleukin 2 was administered subcutaneously daily from 1 week before to 12 weeks after infusion. |
| Measure | Description | Time Frame |
|---|---|---|
| To evaluate the incidence of DLT in patients with refractory cGVHD treated with donor-derived Treg cell injection combined with low dose rhIL-2 injection | To evaluate the incidence of DLT in patients with refractory cGVHD treated with donor-derived Treg cell injection combined with low dose rhIL-2 injection。 DLT is defined as any of the following conditions related to the study drug within 28 days after the subject's infusion of Treg cell injection, despite treatment:
| Up to day 28 |
| Incidence of grade 3 and above adverse reactions | Incidence of adverse events associated with the study products;Adverse events assessed according to NCI-CTCAE v5.0. | Through study completion, an average of 2 year |
| Measure | Description | Time Frame |
|---|---|---|
| Evaluate the number of Treg cells in subjects' peripheral blood | Evaluate the number of Treg cells in subjects' peripheral blood after donor-derived Treg cell injection administration | An average of 1 year |
| Analysis of the number changes of lymphocyte subsets in peripheral blood. |
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Inclusion Criteria:
Subjects aged 18-70 years old, male or female;
The subjects had received allo-HSCT, including cord blood transplantation;
TSubjects with moderate/severe cGVHD that meets the NIH diagnostic criteria (031) for steroid dependence or resistance, meeting one of the following:
Prednisone dose > 0.25 mg/kg/d for more than 4 weeks; Subjects must maintain a stable prednisone dose for 4 weeks prior to the first Treg cell infusion and not increase or discontinue other immunosuppressants (including cyclosporine, tacrolimus, and sirolimus);
The ECOG score of the subjects was 0-2;
the expected survival of the subject is more than 3 months;
Liver, kidney, heart and lung function meet the following requirements (except liver and kidney dysfunction caused by cGVHD) :
Hematopoietic function: neutrophils >1×10^9/L, platelets >25×10^9/L; Supportive treatments such as platelet transfusion and other cytokines are excluded.
The subject or the subject's guardian can understand this experiment and has signed the informed consent.
Donor age 14-70 years old, male or female;
The ECOG score of the donor is 0-1;
The donor must be a hematopoietic stem cell donor who underwent allo-HSCT prior to the subject;
Female donors must test negative for serum or urine beta-human chorionic gonadotropin (HCG) within 3 weeks of blood collection;
The donor can establish the necessary venous access for collection, without the contraindication of white blood cell collection; If peripheral venous leukocyte collection is insufficient, be willing to insert a central catheter; (15) The donor agrees to donate and signs a consent form.
Exclusion Criteria:
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| xianmin song, Doctor | Contact | 18616705298 | shongxm@139.com |
| Name | Affiliation | Role |
|---|---|---|
| xianmin song, Doctor | Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Shanghai General Hospital | Recruiting | Shanghai | 200080 | China |
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single-arm, open-label, dose-escalation clinical trial
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Analysis of the number changes of lymphocyte subsets in peripheral blood, Including T/B/NK cells. |
| Through study completion, an average of 2 year |
| Score changes in the 36-Item Short Form Health Survey (SF-36) | Adopt 36-Item Short Form Survey (SF-36)to analyze the changes in patients' scores after medication compared with baseline. | Through study completion, an average of 2 year |
| Score changes in Lee Chronic Graft-versus-Host Disease Symptom Scale | Adopt 36-Item Short Form Survey (SF-36)to analyze the changes in patients' scores after medication compared with baseline. | Through study completion, an average of 2 year |
| Changes in cGVHD severity | Changes in cGVHD severity,according to chronic graft-versus-host disease grading system. | Through study completion, an average of 2 year |
| Objective Response Rate (ORR) | To evaluate the efficacy of donor-derived Treg cells combined with low-dose IL-2 in the treatment of refractory cGVHD subjects, including 12 and 24 weeks of ORR. | Through study completion, an average of 2 year |
| Patient-reported Outcomes | Reports directly from patients on their own health, functional status, and treatment experience, excluding explanations from health care workers or anyone else. A score of ≥7 on the Lee cGVHD Symptom Scale was associated with improved quality of life. | Through study completion, an average of 2 year |
| Proportion of subjects able to reduce steroid requirement to <0.25 mg/kg/ day. | Proportion of subjects able to reduce steroid requirement to <0.25 mg/kg/ day. | Through study completion, an average of 2 year |
| Duration of response after administration (DOR) | Duration of response after administration (DOR),Defined as the time between first remission and disease progression, new cGvHD systemic treatment, or all-cause death, whichever occurs first. | Through study completion, an average of 2 year |
| Failure-free survival after administration (FFS) | Failure-free survival after administration (FFS),The time from the beginning of cell reinfusion to the first disease progression, recurrence after remission, or death from any cause. | Through study completion, an average of 2 year |
| Overall survival | The time from cell retransfusion to death from any cause. | Through study completion, an average of 2 year |
| ID | Term |
|---|---|
| D000092122 | Bronchiolitis Obliterans Syndrome |
| ID | Term |
|---|---|
| D000092124 | Organizing Pneumonia |
| D001989 | Bronchiolitis Obliterans |
| D001988 | Bronchiolitis |
| D001991 | Bronchitis |
| D001982 | Bronchial Diseases |
| D012140 | Respiratory Tract Diseases |
| D008173 | Lung Diseases, Obstructive |
| D008171 | Lung Diseases |
| D006086 | Graft vs Host Disease |
| D007154 | Immune System Diseases |
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| ID | Term |
|---|---|
| D007376 | Interleukin-2 |
| ID | Term |
|---|---|
| D007378 | Interleukins |
| D016207 | Cytokines |
| D036341 | Intercellular Signaling Peptides and Proteins |
| D010455 | Peptides |
| D000602 | Amino Acids, Peptides, and Proteins |
| D008222 | Lymphokines |
| D011506 | Proteins |
| D001685 | Biological Factors |
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