CAR-T细胞桥接异基因造血干细胞移植治疗复发/难治急性B淋巴细胞白血病的临床分析

OBJECTIVE: This study aims to investigate the efficacy and safety of chimeric antigen receptor（CAR）T-cell bridging allogeneic hematopoietic stem cell transplantation（allo-HSCT）in the treatment of recurrent and refractory acute B-lymphocytic leukemia（R/R B-ALL）. METHODS: A total of 50 R/R B-ALL patients who underwent CAR T-scell therapy to bridge allo-HSCT in the First Affiliated Hospital of Soochow University from January 2017 to May 2019 were retrospectively analyzed. The overall survival（OS）rate, event-free survival（EFS）rate, cumulative recurrence rate（CIR）, and transplant-related mortality（TRM）of patients with different bone marrow minimal residual disease （MRD）levels were analyzed before and after CAR T-cell infusion and before allo-HSCT. RESULTS: The response rate of CAR T-cell therapy and the incidence rate of severe cytokine release syndrome were 92％ and 28％, respectively. During 55 infusions, no treatment-related deaths occurred in any of the patients. The median time of CAR T-cell infusion to allo-HSCT was 54（26–232）days, the median follow-up time after CAR T-cell infusion was 637（117–1097）days, and the 1-year OS and EFS rates were（80.0±5.7）％ and （60.0±6.9）％. The 1-year CIR and TRM after allo-HSCT were（28.0±0.4）％ and（8.0±0.2）％. After CAR T-cell infusion and before allo-HSCT, patients with bone marrow MRD<0.01％ had a significantly longer EFS［（70.0±7.2）％ vs（20.0±12.6）％, P<0.001;（66.7±7.5）％ vs（36.4±14.5）％, P＝0.008］and lower CIR［（25.0 ± 0.5）％ vs （70.0 ± 2.6）％，P<0.001; （23.08 ± 0.47）％ vs （45.45 ± 2.60）％，P＝0.038］. CONCLUSION: CAR T-cell therapy bridging allo-HSCT is safe and effective for recurrent and refractory B-ALL.