Abstract：
The one-year survival rate for patients experiencing a relapse of B-cell acute lymphocytic leukemia (B-ALL) following hematopoietic stem cell transplantation (HSCT) is approximately 30%. Patients experiencing a relapse after allogeneic HSCT frequently encounter difficulties in obtaining autologous CAR-T products. We conducted a study involving 14 patients who received donor-derived CAR-T therapy for relapsed B-ALL following HSCT between August 2019 and May 2023 in our center. The results revealed a CR/CRi rate of 78.6% (11/14), a GVHD rate of 21.4% (3/14), and a 1-year overall survival (OS) rate of 56%. Decreased bone marrow donor cell chimerism in 9 patients recovered after CAR-T therapy. The main causes of death were disease progression and infection. Further analysis showed that GVHD (HR 7.224, 95% CI 1.42-36.82, P = 0.017) and platelet recovery at 30 days (HR 6.807, 95% CI 1.61-28.83, P = 0.009) are significantly associated with OS after CAR-T therapy. Based on the findings, we conclude that donor-derived CAR-T cells are effective in treating relapsed B-ALL patients following HSCT. Additionally, GVHD and poor platelet recovery impact OS, but further verification with a larger sample size is needed.
摘要：
造血干细胞移植（HSCT）后B细胞急性淋巴细胞白血病（B-ALL）复发的患者的一年生存率约为30％。在同种异体HSCT后经历复发的患者在获得自体CAR-T产品时经常遇到困难。我们在我们中心进行了一项研究，涉及14名患者，他们在2019年8月至2023年5月期间接受供体衍生的CAR-T治疗HSCT后复发B-ALL。结果显示，CR/CRi率为78.6%(11/14)，GVHD率为21.4%(3/14)，1年总生存率（OS）为56％。CAR-T治疗后9例患者的骨髓供体细胞嵌合体减少。死亡原因主要为疾病进展和感染。进一步分析表明，GVHD（HR7.224，95％CI1.42-36.82，P=0.017）和30天血小板恢复（HR6.807，95％CI1.61-28.83，P=0.009）与CAR-T治疗后的OS显着相关。根据调查结果,我们得出的结论是，供体来源的CAR-T细胞可有效治疗HSCT后复发的B-ALL患者。此外,GVHD和血小板恢复不良影响OS，但需要用更大的样本量进一步验证。
