Consolidative Hematopoietic Stem Cell Transplantation After CD19 CAR-T Cell Therapy for Acute Lymphoblastic Leukemia: A Systematic Review and Meta-analysis

Frontiers in Oncology

Zijing Zhao¹  Sanfang Tu¹  Yuhua Li¹  Sifei Chen¹  Shengkang Huang¹  Xinyi Xiao¹  Xinjie Xu²  Zhaochang Huo³ 

[1] Department of Hematology, Zhujiang Hospital, Southern Medical University, Guangzhou, China;State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China;The Second School of Clinical Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, China;

关键词: meta-analysis;    acute lymphoblastic leukemia;    CD19;    hematopoietic stem-cell transplantation;    chimeric antigen receptor T (CAR-T);   

DOI  :  10.3389/fonc.2021.651944

来源: DOAJ

【 摘 要 】

BackgroundThis study aimed to systematically evaluate and compare the efficacy and safety of consolidative hematopoietic stem cell transplantation (HSCT) after CD19 chimeric antigen receptor T (CAR-T) therapy with non-HSCT in the treatment of acute lymphoblastic leukemia (ALL).MethodsThe PubMed, Embase, Cochrane Library and Web of Science databases were searched for clinical trials. Pooled hazard ratios (HRs) for overall survival (OS), relapse rate, and leukemia-free survival (LFS) as well as overall incidence rates for transplant-related mortality (TRM), acute graft-versus-host disease (aGVHD), chronic graft-versus-host disease (cGVHD), and infections were calculated using Stata software.ResultsWe screened 3,441 studies and identified 19 eligible studies with 690 patients. Among the patients who achieved complete remission (CR) after CD19 CAR-T therapy, consolidative HSCT was beneficial for OS (HR = 0.34, 95% CI, 0.17–0.68, P = 0.003), the relapse rate (HR = 0.16, 95% CI, 0.10–0.25, P < 0.001), and LFS (HR = 0.15, 95% CI, 0.08–0.28, P < 0.001). For patients who achieved MRD-negative (neg) CR after CD19 CAR-T therapy, consolidative HSCT was beneficial for OS (0.57, 95% CI, 0.33–0.99, P = 0.045), the relapse rate (0.14, 95% CI, 0.06–0.31, P < 0.001), and LFS (0.21, 95% CI, 0.12–0.35, P < 0.001). Regarding safety, we calculated pooled incidence rates for TRM (8%, 95% CI, 0.02–0.15), aGVHD (44%, 95% CI, 0.23–0.67), cGVHD (36%, 95% CI, 0.17–0.56), and infections (39%, 95% CI, 0.03–0.83).ConclusionsCompared with non-HSCT treatment, consolidative HSCT after CD19 CAR-T therapy for R/R B-ALL patients can prolong OS and LFS and reduce the risk of relapse. The incidence rates for adverse events are acceptable. More high-quality randomized controlled trials are required to avoid bias and further determine the efficacy of HSCT.

【 授权许可】

Unknown