Efficacy and safety of chimeric antigen receptor T-cell therapy followed by allogeneic hematopoietic stem cell transplantation in 21 patients with Ph-like acute lymphoblastic leukemia
Efficacy and safety of chimeric antigen receptor T-cell therapy followed by allogeneic hematopoietic stem cell transplantation in 21 patients with Ph-like acute lymphoblastic leukemia
Objective To evaluate the efficacy and safety of chimeric antigen receptor T-cell(CAR-T)therapy followed by allogeneic hematopoietic stem cell transplantation(allo-HSCT)in patients with Ph-like acute lymphoblastic leukemia(Ph-ALL).Methods Patients with Ph-ALL who underwent CAR-T therapy followed by allo-HSCT from March 2018 to August 2023 at the First Affiliated Hospital of Soochow University were included,and their clinical data were retrospectively analyzed.Results Of the 21 patients,14 were male and 7 were female.The median age at the time of CAR-T therapy was 22(6-50)years.Seven patients had ABLl-like rearrangements,and 14 had JAK-STAT rearrangements.Prior to CAR-T therapy,12 patients experienced hematologic relapse;7 were multiparameter flow cytometry minimal residual disease(MFC-MRD)-positive and 2 were MFC-MRD-negative.CAR-T cells were derived from patients'autologous lymphocytes.Nine patients were treated with CD 19 CAR-T cells,and 12 were treated with CD19/CD22 CAR-T cells.After assessment on day 28 after CAR-T therapy,95.2％of the patients achieved complete remission,with an MRD-negative remission rate of 75％.Nineteen patients developed grade 0-2 cytokine release syndrome(CRS)and 2 patients suffered grade 3 CRS,all cases of which resolved after treatment.All patients underwent allo-HSCT after CAR-T therapy.The median time from CAR-T therapy to allo-HSCT was 63(38-114)days.Five patients experienced relapse after CAR-T therapy,including four with hematologic relapse and one with molecular relapse.The 3-year overall survival(OS)rates in the ABL1 and JAK-STAT groups were(83.3±15.2)％and(66.6±17.2)％,respectively(P=0.68).The 3-year relapse-free survival(RFS)rates were(50.0±20.4)％and(55.6± 15.4)％in the ABL1 and JAK-STAT groups,respectively.There was no significant difference in 3-year OS or RFS between the two groups.Conclusions CAR-T therapy followed by allo-HSCT leads to rapid remission in most patients with Ph-ALL and prolongs leukemia-free survival.
关键词
嵌合抗原受体T细胞/异基因造血干细胞移植/Ph样/白血病,淋巴细胞,急性
Key words
Chimeric antigen T cell/allogenic hematopoietic stem cell transplantation/Ph-like/Acute lymphoblastic leukemia
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