R/R B-ALL: can transplantation prolong benefits of CAR-T cell therapy?

  • Jiang H & al.
  • Am J Hematol
  • 18 Jul 2019

  • curated by David Reilly
  • Univadis Clinical Summaries
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Takeaway

  • Consolidative allogeneic hematopoietic stem cell transplant (allo-HSCT) following chimeric antigen receptor T (CAR-T) cell therapy delivered significant improvements in event-free survival (EFS) and relapse-free survival (RFS) in patients with relapsed/refractory B-cell acute lymphoblastic leukemia (R/R B-ALL) and high (≥5%) preinfusion bone marrow minimal residual disease by flow cytometry (BM-FCM-MRD) or poor prognostic markers.

Why this matters

  • Patients who have achieved complete remission (CR) with CAR-T cell therapy remain at high risk of relapse.

Study design

  • Study to investigate allo-HSCT following anti-CD19 CAR-T cell therapy in 58 patients with R/R B-ALL.
  • Funding: National Natural Science Foundation of China; Major Technological Innovation Special Project of Hubei Province of China.

Key results

  • 58 patients received CAR-T cell therapy, among whom 87.9% achieved CR.
  • No significant difference in OS in patients with vs without transplant: P=.099.
  • Improved EFS with transplant vs without: P=.021.
  • Improved RFS with transplant vs without: P=.001.
  • Significantly improved EFS and RFS in transplanted patients with:
    • High (≥5%) BM-FCM-MRD: P=.032 and .0031, respectively.
    • Preinfusion BM-FCM-MRD

Limitations

  • Nonrandomized study.