Taraseviciute Agne, Broglie Larisa, Phelan Rachel, Bhatt Neel S, Becktell Kerri, Burke Michael J
Division of Pediatric Hematology, Oncology and Blood and Marrow Transplantation, Children's Hospital Los Angeles, Los Angeles, CA.
Division of Pediatric Hematology-Oncology-Stem Cell Transplant, Columbia University Medical Center, New York, NY.
J Pediatr Hematol Oncol. 2019 Jul;41(5):337-344. doi: 10.1097/MPH.0000000000001479.
CD19 chimeric antigen receptor T-cell (CART) therapy has revolutionized the treatment of patients with relapsed/refractory hematologic malignancies, especially B-cell acute lymphoblastic leukemia. As CART immunotherapy expands from clinical trials to FDA-approved treatments, a consensus among oncologists and hematopoietic cell transplant (HCT) physicians is needed to identify which patients may benefit from consolidative HCT post-CART therapy. Here, we review CD19 CART therapy and the outcomes of published clinical trials, highlighting the use of post-CART HCT and the pattern of relapse after CD19 CART. At this time, the limited available long-term data from clinical trials precludes us from making definitive HCT recommendations. However, based on currently available data, we propose that consolidative HCT post-CART therapy be considered for all HCT-eligible patients and especially for pediatric patients with KMT2A-rearranged B-cell acute lymphoblastic leukemia.
CD19嵌合抗原受体T细胞（CART）疗法彻底改变了复发/难治性血液系统恶性肿瘤患者的治疗方式，尤其是B细胞急性淋巴细胞白血病。随着CART免疫疗法从临床试验扩展到美国食品药品监督管理局（FDA）批准的治疗方法，肿瘤学家和造血细胞移植（HCT）医生需要达成共识，以确定哪些患者可能从CART治疗后的巩固性HCT中获益。在此，我们回顾CD19 CART疗法和已发表临床试验的结果，强调CART治疗后HCT的应用以及CD19 CART治疗后的复发模式。目前，临床试验中有限的长期可用数据使我们无法做出明确的HCT推荐。然而，基于目前可用的数据，我们建议对于所有符合HCT条件的患者，尤其是患有KMT2A重排的B细胞急性淋巴细胞白血病的儿科患者，考虑在CART治疗后进行巩固性HCT。
