Journal of advanced research · 2025
Sequential allogeneic HSCT after CAR-T therapy for relapsed/refractory acute lymphoblastic leukemia patients: A long-term follow-up result.
СтатьяПоддержка исследования: вне правительства СШАНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
Загрузка состояния…
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Yang Tingting, Dong Yetian, Shi Jimin, Zhang Mingming, Kong Delin, Feng Jingjing, Fu Shan, Xiao Pingnan, Hong Ruimin, Xu Huijun, Luo Yi, Zhao Yanmin, Yu Jian, Lai Xiaoyu, Liu Lizhen, Fu Huarui, Ye Yishan, Cui Dawei, Cui Jiazhen, Huang Simao, Wei Guoqing, Chang Alex H, Huang He, Hu Yongxian
Аннотация
INTRODUCTION: CAR-T cell therapy has revolutionized the therapeutic landscape for relapsed/refractory (R/R) B-cell acute lymphoblastic leukemia (B-ALL), and bridging with allogeneic hematopoietic stem cell transplantation (allo-HSCT) has the potential to lower relapse rates. Nevertheless, the majority of existing studies have exclusively focused on short-term outcomes, resulting in a lack of comprehensive understanding of the long-term sustainability of overall prognosis.
OBJECTIVES: Our study aimed to provide real-world, long-term follow-up data for patients who underwent sequential therapy.
METHODS: Patients with R/R B-ALL who achieved MRD-CR following CAR-T therapy and subsequently underwent allo-HSCT between January 2016 and May 2024 were enrolled. The primary outcomes included overall survival (OS), leukemia-free survival (LFS), non-relapse mortality (NRM) and cumulative incidence of relapse (CIR). Acute and chronic graft-versus-host disease (GVHD) and graft-versus-host disease-free survival (GRFS) were also investigated.
RESULTS: The median age at transplant of 32.1 years. Of these patients, 88.2 % underwent haploidentical-HSCT, and 11.8 % received either unrelated matched or related matched HSCT. The cumulative incidences of grades I-IV and grade II-IV aGVHD at day 100 were 31.4 % and 15.7 %, respectively. The cumulative incidence of cGVHD at 4 years was 48.3 %. With a median follow-up time of 43.2 months, OS, LFS, and GRFS at 4 years were 68.9 %, 61.4 %, and 39.5 %, respectively. Fifteen cases (29.4 %) experienced relapse, predominantly antigen-positive relapse (n = 11). NRM and CIR at 4 years were 10.6 % and 28.0 %, respectively. In the multivariate analyses, patients over 45 years of age and with poor-risk had significantly dismal OS (P = 0.018; P = 0.038) and LFS (P = 0.01; P = 0.03).
CONCLUSION: Our study exhibits favorable long-term outcomes consistent with those reported in clinical trials, with sustained, durable responses observed at the 4-year follow-up. However, these benefits are less pronounced in older patients and those with poor-risk disease characteristics.
OBJECTIVES: Our study aimed to provide real-world, long-term follow-up data for patients who underwent sequential therapy.
METHODS: Patients with R/R B-ALL who achieved MRD-CR following CAR-T therapy and subsequently underwent allo-HSCT between January 2016 and May 2024 were enrolled. The primary outcomes included overall survival (OS), leukemia-free survival (LFS), non-relapse mortality (NRM) and cumulative incidence of relapse (CIR). Acute and chronic graft-versus-host disease (GVHD) and graft-versus-host disease-free survival (GRFS) were also investigated.
RESULTS: The median age at transplant of 32.1 years. Of these patients, 88.2 % underwent haploidentical-HSCT, and 11.8 % received either unrelated matched or related matched HSCT. The cumulative incidences of grades I-IV and grade II-IV aGVHD at day 100 were 31.4 % and 15.7 %, respectively. The cumulative incidence of cGVHD at 4 years was 48.3 %. With a median follow-up time of 43.2 months, OS, LFS, and GRFS at 4 years were 68.9 %, 61.4 %, and 39.5 %, respectively. Fifteen cases (29.4 %) experienced relapse, predominantly antigen-positive relapse (n = 11). NRM and CIR at 4 years were 10.6 % and 28.0 %, respectively. In the multivariate analyses, patients over 45 years of age and with poor-risk had significantly dismal OS (P = 0.018; P = 0.038) and LFS (P = 0.01; P = 0.03).
CONCLUSION: Our study exhibits favorable long-term outcomes consistent with those reported in clinical trials, with sustained, durable responses observed at the 4-year follow-up. However, these benefits are less pronounced in older patients and those with poor-risk disease characteristics.