Fourth-gen CAR T Cells Targeting CD19/CD22 for Highly Resistant B-cell Lymphoma/Leukemia (PMBCL/CNS-BCL).

This clinical trial involves the use of Chimeric Antigen Receptor T-cell (CAR-T) therapy targeting CD19 and CD22 in patients with various hematologic malignancies, including B-cell acute lymphoblastic leukemia (B-ALL), B-cell lymphomas, refractory non-Hodgkin lymphoma, chronic lymphocytic leukemia (CLL), diffuse large B-cell lymphoma (DLBCL), lymphoid leukemia, and cases positive for minimal residual disease (MRD). CD19 and CD22 are cell surface molecules commonly found on B cells, and their targeted therapy using CAR-T cells has shown promise in the treatment of these malignancies. Intervention: The intervention in this clinical trial involves the infusion of Human CD19-CD22 Targeted T Cells, which have been genetically engineered to express chimeric antigen receptors specific to CD19 and CD22. These CAR-T cells are designed to recognize and bind to CD19 and CD22 molecules on the surface of malignant B cells, leading to their destruction. The infusion of CAR-T cells will be administered to eligible participants as part of their treatment regimen. Objectives: The primary objectives of this intervention are as follows: To evaluate the safety and tolerability of the CD19 and CD22 CAR-T cell therapy. To assess the pharmacokinetic characteristics of the infused CAR-T cells. To preliminarily observe the clinical effectiveness of CD19 and CD22 CAR-T cell therapy in various hematologic malignancies, including B-ALL, B-cell lymphomas, refractory non-Hodgkin lymphoma, CLL, DLBCL, lymphoid leukemia, and MRD-positive cases. To determine the clinically applicable dose and reinfusion regimen for phase II trials. Mechanism of Action: CD19 and CD22 are cell surface antigens commonly expressed on B-cell malignancies. The CD19-CD22 CAR-T cells are engineered to express a chimeric antigen receptor composed of an extracellular domain that recognizes CD19 and CD22, a transmembrane domain, and intracellular signaling domains. When these modified T cells encounter B cells expressing CD19 and CD22, the CAR-T cells are activated, leading to their binding to the malignant B cells. This binding triggers a cytotoxic response, resulting in the destruction of the target B cells. Treatment Regimen: Prior to the infusion of CD19-CD22 CAR-T cells, participants will undergo preconditioning chemotherapy. This chemotherapy serves to prepare the patient's immune system for the CAR-T cell therapy. Following chemotherapy, participants will receive the infusion of CD19-CD22 CAR-T cells. Monitoring and Follow-up: After the CAR-T cell infusion, participants will be closely monitored for side effects and adverse events. Additionally, the clinical response and effectiveness of CD19-CD22 CAR-T cells in controlling the malignancy will be assessed through various evaluations, including disease assessments, imaging studies (CT, MRI, PET), and blood tests. These assessments may be performed while participants are hospitalized. Rationale: CD19 and CD22 are well-established targets for CAR-T cell therapy in B-cell malignancies. By targeting both CD19 and CD22, this approach aims to maximize the therapeutic benefit and expand the applicability of CAR-T therapy to a broad spectrum of hematologic malignancies. The rationale behind this clinical trial is to further evaluate the safety, efficacy, and optimal dosing regimens of CD19 and CD22 CAR-T cells in various patient populations with these malignancies. Ultimately, the goal is to provide a promising treatment option for patients with relapsed/refractory B-cell malignancies, including those with central nervous system involvement, who have limited therapeutic alternatives.