In a nutshell
This study aimed to investigate if a hemopoietic stem cell transplant should be carried out after chimeric antigen receptor T cell therapy in patients with B-cell acute lymphoblastic leukemia.
This study concluded that this treatment path led to high event-free survival in these patients.
Some background
Chimeric antigen receptor T cell (CAR-T) therapy is a treatment that uses a patient's own immune system cells to attack cancer. The cells are removed from a patient, modified in the lab, and re-injected into the patient. CAR-T has achieved high complete remission (CR – all signs of cancer gone) in patients with relapsed/refractory B-cell acute lymphoblastic leukemia (B-ALL).
Allogenic hematopoietic stem cell transplant (allo-HSCT) is where the cells of a donor are transplanted into the patient to replace healthy cells killed during cancer treatment. Allo-HSCT can be used to sustain remission for ALL patients.
It was unknown if allo-HSCT would be safe and effective if carried out after CAR-T treatment in patients with B-ALL.
Methods & findings
This study involved 52 patients with relapsed/refractory B-ALL. All patients underwent allo-HSCT after CR from CAR-T. The average time from CAR-T treatment to allo-HSCT was 50 days. Reduced-intensity conditioning (RIC) with total body irradiation/fludarabine-based or busulfan/fludarabine-based regimens were used before allo-HSCT. This is a treatment to get rid of cancer cells. Patients were followed for an average of 334 days.
Graft-versus-host-disease (GVHD) can happen when the transplanted cells attack the body of the patient. This can lead to a failure of allo-HSCT. 23.1% experienced medium to serious short-term GVHD and 5.8% of patients experienced severe short-term GVHD. 16 patients experienced long-term GVHD.
The one-year overall survival rate was 87.7%. The one-year survival rate without complications from the disease was 73%. The one-year relapse rate was 24.7%.
The bottom line
This study concluded that in patients with relapsed/refractory B-ALL, allo-HSCT after CAR-T therapy led to good outcomes.
The fine print
This study had a short follow-up period. Long term studies are needed.
Published By :
British Journal of Haematology
Date :
Mar 29, 2020
