Unmanipulated haploidentical hematopoietic stem cell transplantation is an excellent option for children and young adult relapsed/refractory Philadelphia chromosome-negative B-cell acute lymphoblastic leukemia after CAR-T-cell therapy

Although chimeric antigen receptor T-cell (CAR-T) therapy produces a high complete remission rate among patients with relapsed/refractory B-cell acute lymphoblastic leukemia, relapse remains an urgent issue. It is uncertain whether consolidative haploidentical-allogeneic hematopoietic stem cell tran...

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Published inLeukemia Vol. 35; no. 11; pp. 3092 - 3100
Main Authors Hu, Guan-Hua, Zhao, Xiang-Yu, Zuo, Ying-Xi, Chang, Ying-Jun, Suo, Pan, Wu, Jun, Jia, Yue-Ping, Lu, Ai-Dong, Li, Ying-Chun, Wang, Yu, Jiao, Shun-Chang, Zhang, Long-Ji, Kong, Jun, Yan, Chen-Hua, Xu, Lan-Ping, Zhang, Xiao-Hui, Liu, Kai-Yan, Cheng, Yi-Fei, Zhang, Le-Ping, Huang, Xiao-Jun
Format Journal Article
LanguageEnglish
Published London Nature Publishing Group UK 01.11.2021
Nature Publishing Group
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Abstract Although chimeric antigen receptor T-cell (CAR-T) therapy produces a high complete remission rate among patients with relapsed/refractory B-cell acute lymphoblastic leukemia, relapse remains an urgent issue. It is uncertain whether consolidative haploidentical-allogeneic hematopoietic stem cell transplantation (haplo-HSCT) is suitable for achieving sustainable remission. Therefore, we aimed to assess the efficacy and safety of bridging CAR-T therapy to haplo-HSCT. Fifty-two patients with relapsed/refractory Philadelphia chromosome-negative B-cell acute lymphoblastic leukemia who underwent haplo-HSCT after CAR-T therapy were analyzed. The median time from CAR-T therapy to haplo-HSCT was 61 days. After a median follow-up of 24.6 months, the 1-year probabilities of event-free survival, overall survival, and cumulative incidence of relapse were 80.1% (95% confidence interval (CI), 69.0–90.9), 92.3% (95% CI, 85.0–99.5), and 14.1% (95% CI, 10.7–17.4), respectively, while the corresponding 2-year probabilities were 76.0% (95% CI, 64.2–87.7), 84.3% (95% CI, 74.3–94.3), and 19.7% (95% CI, 15.3–24.0), respectively. No increased risk of 2-year cumulative incidence of graft-versus-host disease, treatment-related mortality, or infection was observed. A pre-HSCT measurable residual disease-positive status was an independent factor associated with poor overall survival (hazard radio: 4.201, 95% CI: 1.034–17.063; P  = 0.045). Haplo-HSCT may be a safe and effective treatment strategy to improve event-free survival and overall survival after CAR-T therapy.
AbstractList Although chimeric antigen receptor T-cell (CAR-T) therapy produces a high complete remission rate among patients with relapsed/refractory B-cell acute lymphoblastic leukemia, relapse remains an urgent issue. It is uncertain whether consolidative haploidentical-allogeneic hematopoietic stem cell transplantation (haplo-HSCT) is suitable for achieving sustainable remission. Therefore, we aimed to assess the efficacy and safety of bridging CAR-T therapy to haplo-HSCT. Fifty-two patients with relapsed/refractory Philadelphia chromosome-negative B-cell acute lymphoblastic leukemia who underwent haplo-HSCT after CAR-T therapy were analyzed. The median time from CAR-T therapy to haplo-HSCT was 61 days. After a median follow-up of 24.6 months, the 1-year probabilities of event-free survival, overall survival, and cumulative incidence of relapse were 80.1% (95% confidence interval (CI), 69.0-90.9), 92.3% (95% CI, 85.0-99.5), and 14.1% (95% CI, 10.7-17.4), respectively, while the corresponding 2-year probabilities were 76.0% (95% CI, 64.2-87.7), 84.3% (95% CI, 74.3-94.3), and 19.7% (95% CI, 15.3-24.0), respectively. No increased risk of 2-year cumulative incidence of graft-versus-host disease, treatment-related mortality, or infection was observed. A pre-HSCT measurable residual disease-positive status was an independent factor associated with poor overall survival (hazard radio: 4.201, 95% CI: 1.034-17.063; P = 0.045). Haplo-HSCT may be a safe and effective treatment strategy to improve event-free survival and overall survival after CAR-T therapy.Although chimeric antigen receptor T-cell (CAR-T) therapy produces a high complete remission rate among patients with relapsed/refractory B-cell acute lymphoblastic leukemia, relapse remains an urgent issue. It is uncertain whether consolidative haploidentical-allogeneic hematopoietic stem cell transplantation (haplo-HSCT) is suitable for achieving sustainable remission. Therefore, we aimed to assess the efficacy and safety of bridging CAR-T therapy to haplo-HSCT. Fifty-two patients with relapsed/refractory Philadelphia chromosome-negative B-cell acute lymphoblastic leukemia who underwent haplo-HSCT after CAR-T therapy were analyzed. The median time from CAR-T therapy to haplo-HSCT was 61 days. After a median follow-up of 24.6 months, the 1-year probabilities of event-free survival, overall survival, and cumulative incidence of relapse were 80.1% (95% confidence interval (CI), 69.0-90.9), 92.3% (95% CI, 85.0-99.5), and 14.1% (95% CI, 10.7-17.4), respectively, while the corresponding 2-year probabilities were 76.0% (95% CI, 64.2-87.7), 84.3% (95% CI, 74.3-94.3), and 19.7% (95% CI, 15.3-24.0), respectively. No increased risk of 2-year cumulative incidence of graft-versus-host disease, treatment-related mortality, or infection was observed. A pre-HSCT measurable residual disease-positive status was an independent factor associated with poor overall survival (hazard radio: 4.201, 95% CI: 1.034-17.063; P = 0.045). Haplo-HSCT may be a safe and effective treatment strategy to improve event-free survival and overall survival after CAR-T therapy.
Although chimeric antigen receptor T-cell (CAR-T) therapy produces a high complete remission rate among patients with relapsed/refractory B-cell acute lymphoblastic leukemia, relapse remains an urgent issue. It is uncertain whether consolidative haploidentical-allogeneic hematopoietic stem cell transplantation (haplo-HSCT) is suitable for achieving sustainable remission. Therefore, we aimed to assess the efficacy and safety of bridging CAR-T therapy to haplo-HSCT. Fifty-two patients with relapsed/refractory Philadelphia chromosome-negative B-cell acute lymphoblastic leukemia who underwent haplo-HSCT after CAR-T therapy were analyzed. The median time from CAR-T therapy to haplo-HSCT was 61 days. After a median follow-up of 24.6 months, the 1-year probabilities of event-free survival, overall survival, and cumulative incidence of relapse were 80.1% (95% confidence interval (CI), 69.0-90.9), 92.3% (95% CI, 85.0-99.5), and 14.1% (95% CI, 10.7-17.4), respectively, while the corresponding 2-year probabilities were 76.0% (95% CI, 64.2-87.7), 84.3% (95% CI, 74.3-94.3), and 19.7% (95% CI, 15.3-24.0), respectively. No increased risk of 2-year cumulative incidence of graft-versus-host disease, treatment-related mortality, or infection was observed. A pre-HSCT measurable residual disease-positive status was an independent factor associated with poor overall survival (hazard radio: 4.201, 95% CI: 1.034-17.063; P = 0.045). Haplo-HSCT may be a safe and effective treatment strategy to improve event-free survival and overall survival after CAR-T therapy.
Although chimeric antigen receptor T-cell (CAR-T) therapy produces a high complete remission rate among patients with relapsed/refractory B-cell acute lymphoblastic leukemia, relapse remains an urgent issue. It is uncertain whether consolidative haploidentical-allogeneic hematopoietic stem cell transplantation (haplo-HSCT) is suitable for achieving sustainable remission. Therefore, we aimed to assess the efficacy and safety of bridging CAR-T therapy to haplo-HSCT. Fifty-two patients with relapsed/refractory Philadelphia chromosome-negative B-cell acute lymphoblastic leukemia who underwent haplo-HSCT after CAR-T therapy were analyzed. The median time from CAR-T therapy to haplo-HSCT was 61 days. After a median follow-up of 24.6 months, the 1-year probabilities of event-free survival, overall survival, and cumulative incidence of relapse were 80.1% (95% confidence interval (CI), 69.0–90.9), 92.3% (95% CI, 85.0–99.5), and 14.1% (95% CI, 10.7–17.4), respectively, while the corresponding 2-year probabilities were 76.0% (95% CI, 64.2–87.7), 84.3% (95% CI, 74.3–94.3), and 19.7% (95% CI, 15.3–24.0), respectively. No increased risk of 2-year cumulative incidence of graft-versus-host disease, treatment-related mortality, or infection was observed. A pre-HSCT measurable residual disease-positive status was an independent factor associated with poor overall survival (hazard radio: 4.201, 95% CI: 1.034–17.063; P  = 0.045). Haplo-HSCT may be a safe and effective treatment strategy to improve event-free survival and overall survival after CAR-T therapy.
Audience Academic
Author Jia, Yue-Ping
Li, Ying-Chun
Zuo, Ying-Xi
Zhao, Xiang-Yu
Wang, Yu
Cheng, Yi-Fei
Jiao, Shun-Chang
Kong, Jun
Yan, Chen-Hua
Zhang, Long-Ji
Wu, Jun
Zhang, Le-Ping
Chang, Ying-Jun
Lu, Ai-Dong
Zhang, Xiao-Hui
Xu, Lan-Ping
Liu, Kai-Yan
Huang, Xiao-Jun
Hu, Guan-Hua
Suo, Pan
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BackLink https://www.ncbi.nlm.nih.gov/pubmed/33824464$$D View this record in MEDLINE/PubMed
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2021. The Author(s), under exclusive licence to Springer Nature Limited.
COPYRIGHT 2021 Nature Publishing Group
The Author(s), under exclusive licence to Springer Nature Limited 2021.
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SSID ssj0014766
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Snippet Although chimeric antigen receptor T-cell (CAR-T) therapy produces a high complete remission rate among patients with relapsed/refractory B-cell acute...
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gale
pubmed
crossref
springer
SourceType Aggregation Database
Index Database
Enrichment Source
Publisher
StartPage 3092
SubjectTerms 13/100
631/67/1990/283/2125
692/699/1541/1990/283/2125
Acute lymphoblastic leukemia
Acute lymphocytic leukemia
Adolescent
Antigens
Cancer
Cancer Research
Care and treatment
Cell therapy
Cellular therapy
Child
Child, Preschool
Children
Chimeric antigen receptors
Chromosomes
Confidence intervals
Critical Care Medicine
Drug Resistance, Neoplasm
Female
Follow-Up Studies
Graft vs Host Disease - etiology
Graft vs Host Disease - pathology
Graft vs Host Disease - therapy
Graft-versus-host reaction
Hematology
Hematopoietic Stem Cell Transplantation - methods
Hematopoietic stem cells
Humans
Immunotherapy, Adoptive - adverse effects
Infant
Intensive
Internal Medicine
Leukemia
Leukemia in children
Lymphatic leukemia
Lymphoblastic leukemia in children
Lymphocytes B
Lymphocytes T
Lymphocytic leukemia in children
Male
Medicine
Medicine & Public Health
Neoplasm Recurrence, Local - pathology
Neoplasm Recurrence, Local - therapy
Oncology
Patient outcomes
Patients
Philadelphia Chromosome
Precursor B-Cell Lymphoblastic Leukemia-Lymphoma - pathology
Precursor B-Cell Lymphoblastic Leukemia-Lymphoma - therapy
Prognosis
Relapse
Remission
Remission (Medicine)
Retrospective Studies
Salvage Therapy
Stem cell transplantation
Stem cells
Survival
Survival Rate
Therapy
Transplantation
Transplantation, Haploidentical
Young adults
Title Unmanipulated haploidentical hematopoietic stem cell transplantation is an excellent option for children and young adult relapsed/refractory Philadelphia chromosome-negative B-cell acute lymphoblastic leukemia after CAR-T-cell therapy
URI https://link.springer.com/article/10.1038/s41375-021-01236-y
https://www.ncbi.nlm.nih.gov/pubmed/33824464
https://www.proquest.com/docview/2586676964
https://www.proquest.com/docview/2509606846
Volume 35
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