Comparable Outcomes in Patients with B-cell Acute Lymphoblastic Leukemia Receiving Haploidentical Hematopoietic Stem Cell Transplantation: Pretransplant Minimal Residual Disease-negative Complete Remission Following Chimeric Antigen Receptor T-cell...

Overview

Journal Front Immunol

Specialty Allergy & Immunology

Date 2022 Sep 16

PMID 36110859

Authors

Ting-Ting Yang

Ye Meng

De-Lin Kong

Guo-Qing Wei

Ming-Ming Zhang

Wen-Jun Wu

Ji-Min Shi

Yi Luo

Yan-Min Zhao

Jian Yu

Rui-Rui Jing

Meng-Yu Zhao

Hou-Li Zhao

He Huang

Yong-Xian Hu

Affiliations

Soon will be listed here.

Abstract

Introduction: Chimeric antigen receptor (CAR) T-cell (CAR-T) therapy followed by haploidentical hematopoietic stem cell transplantation (haplo-HSCT) markedly improves the long-term survival of patients with refractory/relapsed (R/R) B-cell acute lymphoblastic leukemia (B-ALL).

Methods: We performed a parallel comparison of transplant outcomes in 168 B-ALL patients undergoing haplo-HSCT after achieving minimal residual disease (MRD)-negative complete remission (CR) from CAR-T therapy (n = 28) or chemotherapy (n = 140) between January 2016 and August 2021. We further divided the chemotherapy group into the first CR group (chemo+CR1, n = 118) and a second or more CR group (chemo+≥CR2, n = 22).

Results: With a median follow-up period of 31.0 months, the 2-year overall survival (OS), leukemia-free survival (LFS), non-relapse mortality (NRM), and relapse rates in the CAR-T and chemotherapy groups did not differ significantly (OS, 87.9% vs. 71.5 %; LFS, 72.0% vs. 66.8%; NRM, 3.9% vs. 13.7%; relapse, 24.1% vs. 19.4%). Multivariate analysis confirmed that ≥CR2 at transplantation following chemotherapy was an independent risk factor associated with poor OS (hazard ratio (HR) 4.22 [95% CI, 1.34-13.293], = 0.014) and LFS (HR 2.57 [95% CI, 1.041-6.343], = 0.041). The probabilities of OS and LFS at 2 years in the CAR-T group were comparable to those in the chemo+CR1 group but significantly higher than those in the chemo+≥CR2 group (OS, 87.9% vs. 37.8%, = 0.007; LFS, 72.0% vs. 41.7%, = 0.043). No significant differences in the incidences of NRM were noted among the three groups.

Conclusions: Our results demonstrated that patients with R/R B-ALL receiving haplo-HSCT after CAR-T therapy achieved comparable outcomes to patients transplanted post-chemotherapy-based MRD-negative CR1, without increased risk of transplant-related mortality and toxicity.

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