CART处理细胞后的异基因造血细胞移植(allo-HCT)在血液恶性肿瘤中的作用目前存在争议。经过几年的随访,长期缓解表明CAR-T细胞疗法具有疗效。而allo-HCT以前被认为是复发情况下唯一的治愈性治疗方法。本次协调研讨会的目的是详细介绍文献中有关CART细胞后allo-HCT可行性的现有数据,并建议在选定的B急性淋巴细胞白血病(B-ALL)患者中考虑同种异体移植和弥漫性大B细胞淋巴瘤(DLBCL)。在B-ALL中,各种内在因素(患者固有的,疾病,CART细胞的类型),尤其是各种CART细胞后标准(早期扩增动力学,D28时残留疾病,早期B细胞再生障碍)应导致考虑在复发发生之前进行allo-HCT。在DLBCL中,尽管在诊断时和CAR-T细胞治疗之前存在复发的风险因素,3个月时通过PET-CT评估的反应非常关键,目前在完全缓解或部分缓解的情况下,不推荐allo-HCT.无论如何,如果年龄适合同种异体移植,HLA分型应在CART细胞治疗之前进行,以便在需要时不延迟allo-HCT项目。
The role of allogeneic hematopoietic cell transplantation (allo-HCT) after CAR T- treatment cells in hematologic malignancies is currently controversial. Prolonged remissions after several years of follow-up suggest that there is a curative effect of CAR T-cells therapy, whereas allo-HCT was previously considered the only curative treatment in relapse situation. The aim of this harmonization workshop is to detail the existing data in the literature on the feasibility of allo-HCT after CAR T-cells and to propose to consider allograft in selected patients with B-acute lymphoblastic leukemia (B-ALL) and diffuse large B-cell lymphoma (DLBCL). In B-ALL, various intrinsic factors (inherent to the patient, to the disease, to the type of CAR T-cells) and especially various post CAR T-cells criteria (early expansion kinetics, residual disease at D28, early loss of B-cell aplasia) should lead to consider performing allo-HCT before the occurrence of a relapse. In DLBCL, although there are risk factors for relapse at diagnosis and prior to CAR T-cells therapy, response assessed by PET-CT at three months is critical and allo-HCT cannot currently be recommended in cases of complete or partial remission. In any case, if the age is appropriate for allogeneic transplantation, HLA typing should be performed before CAR T-cells treatment in order not to delay the allo-HCT project if needed.