抗CD19 CAR-T细胞序贯异基因造血干细胞移植术治疗难治B淋巴细胞白血病疗效及安全性观察

OBJECTIVE: To investigate the efficacy and side effects of anti-CD19 CAR-T cell bridging to allogeneic hematopoietic stem cell transplantation （allo-HSCT） regimen for refractory Blymphoblastic leukemia. METHODS: 10 patients with refractory B-lymphoblastic leukemia with minimal residual disease（MRD）negative after anti-CD19 CAR-T cell treatment, then bridging to allo-HSCT from November 2017 to March 2019 in the Affiliated Cancer Hospital of Zhengzhou University were retrospectively analyzed. RESULTS: ①Among 10 patients, 5 were males and 5 females, with a median age of 23.6（10–31）years. 9 patients were diagnosed refractory acute lymphoblastic leukemia and the other one was chronic lymphoblastic leukemia. 10 patients reached MRD negative 30 days after anti-CD19 CART cell. ②The donors were identical sibling（2 cases）and haploidentical family member（8 cases）. The median time from MRD negative after CAR-T treatment to transplantation were 32.5（20–60）days. ③10 patients obtained complete haploidentical engraftment. The median time of neutrophil implantation was 15（15–21）days, and 19（17–30）days of platelet implantation. ④ After conditioning, no hepatic venoocclusive disease and hemorrhagic cystitis occurred. One patient had leakage syndrome and got improved after intervention such as limited water entry, albumin supplementation and diuresis. 8（80％）patients had fever, 2 cases experienced acute graft-versus-host disease（GVHD）grade Ⅱ, 1 case with aGVHD grade Ⅲ. Among 9 survivals, localized chronic GVHD occurred in 8 patients. ⑤The median follow-up was 262（150–540）days and the estimated 1-years overall survivaln（OS）and disease free survival（DFS）were（90.0±1.0）％ and （85.7 ± 1.3）％, respectively. CONCLUSION: Anti-CD19 CAR-T cell bridging to allo-HSCT regimen is a feasible choice with favorable outcome for refractory B-lymphoblastic leukemia.