The FDA has authorized CD28-based CD19 chimeric antigen receptor-modified (CAR-)T cells for adult acute lymphoblastic leukemia (ALL). For a study, researchers presented the long-term results of 37 children and young adults treated with autologous CD19 CAR-T cells. The overall remission rate was 86%, with 71% having polymerase chain reaction (PCR) minimum residual disease (MRD), 14% having MRD by flow cytometry, and 14% having PCR MRD. About 26 patients had further hematopoietic stem cell transplantation (HSCT). There were 11 CD19-positive relapses (eight after HSCT and three without) and one CD19-negative recurrence. All relapses happened within two years after starting cell treatment. The median event-free survival (EFS) is 17 months with a three-year median follow-up, and the median overall survival (OS) was not met. The three-year EFS is 41%, whereas the OS is 56%. Prior to lymphodepletion, patients having more than 5% blasts in their bone marrow had a lower EFS. After CAR-T cell treatment, all patients who had a PCR MRD-positive result on day 28 had relapsed. Prior HSCT had little effect on the outcome, but consolidation after remission enhanced long-term outcomes.
Reference:onlinelibrary.wiley.com/doi/10.1111/bjh.18105
