Axicabtagene Ciloleucel Injection in Patients With Relapsed/Refractory Follicular Lymphoma

This study is a single-arm, multicenter, prospective Phase II clinical trial, planning to enroll 30 Chinese subjects with relapsed/refractory follicular lymphoma (R/R FL) who will receive Axicabtagene Ciloleucel Injection. The study aims to assess the efficacy and safety of Axicabtagene Ciloleucel Injection in treating Chinese patients with R/R FL.

Inclusion criteria

• Histologically confirmed follicular lymphoma (FL) grade 1, 2, or 3a according to WHO 2016 classification criteria
• Subjects with relapsed or refractory FL after prior second-line or higher therapy Prior therapy must include: anti-CD20 monoclonal antibody in combination with an alkylating agent (anti-CD20 monoclonal antibody monotherapy is not eligible as a line of therapy for eligibility). Subjects who have had stable disease (no recurrence) for more than 1 year after completion of their last treatment do not meet the enrollment criteria Translated with DeepL.com (free version)
• At least one measurable lesion according to the Lugano 2014 classification (Cheson 2014). Lesions with prior radiotherapy were considered measurable only if definitive progression was confirmed after completion of radiotherapy.
• Patients with FL lymphoma secondary to central may be included in the
• Previous systemic therapy at least 2 weeks or 5 half-lives (whichever is shorter) from the start of leukapheresis, except for immune checkpoint inhibitors/agonists; Systemic immune checkpoint inhibitor/agonist therapy at least 3 half-lives from leukapheresis (e.g., Ipilimumab, Ivolumab, Pembrolizumab, Atezolizumab, OX40 agonist, 4-IBB agonist). Atezolizumab, OX40 agonist, 4-IBB agonist)
• Toxic reactions from prior anti-lymphoma therapy must stabilize and recover to ≤ grade 1 (except for non-clinically significant toxicities such as alopecia/balding)
• ≥ 18 years old
• ECOG physical status score of 0 or 1
• Absolute neutrophil count (ANC) ≥ 1.0×10^9/L
• Platelet count ≥ 75×10^9/L
• Absolute lymphocyte count ≥ 0.1×10^ 9/L
• Adequate renal, hepatic, pulmonary, and cardiac function, defined as: 1) total bilirubin (TBIL) ≤ 1.5 times the upper limit of normal (ULN), except in subjects with Gilbert's syndrome; 2) alanine aminotransferase (ALT) and aspartate aminotransferase (AST) ≤ 2.5 x ULN 3) serum creatinine (Cr) ≤ 1.5 x ULN or creatinine clearance (CCr) ≥ 60 mL/min, with creatinine clearance estimated based on the cockcroft-Gault formula; 4) cardiac ejection fraction ≥ 50%, absence of pericardial effusion as determined by echocardiography (ECHO), and absence of clinically significant cardiac arrhythmia; 5) baseline transcutaneous oxygen saturation > 92% under room ventilation; 6) absence of clinically significant chest pain; and ) absence of clinically significant pleural effusion.
• A negative serum pregnancy test is required for women of childbearing potential (women who have been surgically sterilized or who are at least 2 years postmenopausal are not considered to be of childbearing potential).

Exclusion criteria

• Converted FL
• Small lymphocytic lymphoma
• The histologic grading of FL was 3b
• lymphoplasmacytic lymphoma
• Subject has had other malignant tumors unless he/she has survived disease-free and has not received antitumor therapy for at least 3 years; except for non-melanoma skin tumors, carcinoma in situ (e.g., cervix, bladder, breast)
• Autologous Hematopoietic Stem Cell Transplantation Within 6 Weeks Prior to Scheduled Infusion of Achille's Bromide Injection
• Has performed allogeneic hematopoietic stem cell transplants
• Previous CD19-targeted therapy
• Previous chimeric antigen receptor cell therapy or other genetically modified T-cell therapy.
• History of severe rapid-onset hypersensitivity reactions to aminoglycosides
• Presence or suspicion of uncontrolled fungal, bacterial, viral or other infections that require intravenous drug therapy
• Known human immunodeficiency virus (HIV) infection or active acute or chronic hepatitis infection (HBV or HCV). Subjects with a history of hepatitis must undergo standard serologic or genetic testing in accordance with the most recent version of clinical guidelines/institutional protocols to confirm resolution of infection prior to enrollment.
• Known history of lymphoma involving the entire gastric wall
• Presence of any indwelling tube or catheter (e.g., percutaneous nephrostomy tube, indwelling urinary catheter, indwelling biliary drain, or pleural/peritoneal/pericardial catheter). Dedicated central venous access catheters such as Port-a-Cath or Hickman catheters are permitted.
• Patients with primary central nervous system lymphoma (PCNSL)
• Subjects with lymphomatous infiltration of the atria or ventricles
• Myocardial infarction, cardiac angioplasty or stenting, unstable angina pectoris, congestive heart failure class II or worse according to the New York Heart Association cardiac classification, or other clinically significant cardiac disease within 12 months prior to enrollment
• Anticipated emergencies requiring urgent treatment due to rapid tumor progression within 6 weeks of leukapheresis (e.g., tumor mass compression, tumor lysis syndrome)
• End-organ damage due to autoimmune disease (e.g., Crohn's disease, rheumatoid arthritis, systemic lupus erythematosus) within the past 2 years, or systemic use of immunosuppressive or other systemic disease-control medications. Subjects with a history of autoimmune hypothyroidism who are on a stable dose of thyroid replacement hormone therapy and type I diabetes mellitus on a stable insulin regimen are eligible for enrollment in this study.
• History of symptomatic deep vein thrombosis (DVT) or pulmonary embolism within 6 months prior to enrollment and history of DVT at the end of the upper extremity within 3 months prior to pretreatment chemotherapy
• Any medical condition that may affect the assessment of safety or efficacy
• Has had a severe rapid-onset hypersensitivity reaction to any of the drugs to be used in this study
• Live, attenuated vaccines administered within ≤6 weeks prior to the start of the pretreatment regimen or whose use is expected to be required during the course of the study;
• Women of childbearing age who are breastfeeding
• Male or female subjects who are unwilling to use contraception from the date of signed informed consent until 6 months after completion of pretreatment chemotherapy, or 6 months after completion of an infusion of Aquilensa
• Male or female subjects who are unwilling to use contraception from the date of signed informed consent until 6 months after completion of pretreatment chemotherapy, or 6 months after completion of an infusion of Aquilensa