Comparison of Allo-HSCT outcomes after CAR-T therapy versus chemotherapy in pediatric patients with relapsed/refractory B-ALL: a retrospective study

BACKGROUND: Hematopoietic stem cell transplantation (HSCT) is a curable treatment for refractory/relapse B-cell acute lymphoblastic leukemia (R/R B-ALL).Traditional chemotherapy or Chimeric antigen receptor T-cell (CAR-T) therapy are both important methods to achieve MRD negativity before HSCT. However, which treatment is preferred needs to be clarified. PATIENTS AND METHODS: In this study, 269. PATIENT: s with R/R B-ALL who underwent allo-HSCT after CAR-T cell therapy (CAR-T, n = 142) or chemotherapy (CT, n = 127) were enrolled from multicenters. RESULTS: The 3-year overall survival (OS) after transplantation was 66.8% in the CAR-T group and 72.3% in the chemotherapy (CT) group. The 3-year relapse-free survival (RFS) was 65.3% in the CAR-T group and 65.9% in the CT group. The 3-year graft-versus-host disease, relapse-free survival (GRFS) and cumulative incidence of relapse (CIR) were also similar between the two groups. Among patients who achieved first complete remission (CR1) before transplantation, the proportion receiving chemotherapy was significantly higher than that receiving CAR-T therapy (37.5% vs. 13.6%; P < 0.001). In this CR1 subgroup, the CT group demonstrated superior outcomes, including improved OS, RFS, and GRFS. CONCLUSION: In pediatric R/R B-ALL, CAR-T bridging to HSCT appears to yield post-transplant survival comparable to chemotherapy, though a higher rate of moderate to severe chronic GVHD was observed. CAR-T may be a reasonable option, but closer GVHD monitoring seems warranted.

Authors

Institutions

Publication Details

Journal
The Oncologist
Published
2026-06-29
DOI
https://doi.org/10.1093/oncolo/oyag247
Primary Topic
Acute Lymphoblastic Leukemia research
Type
article
Field-Weighted Citation Impact
0.00
Controls
|||
ALL TIME
JAN
FEB
MAR
APR
MAY
JUN
JUL
AUG
SEP
OCT
article

Comparison of Allo-HSCT outcomes after CAR-T therapy versus chemotherapy in pediatric patients with relapsed/refractory B-ALL: a retrospective study

Chi-Kong LI, Xiaoyan Wu, 何光翠, J R Chen et al.
The Oncologist
Acute Lymphoblastic Leukemia research
article

Comparison of Allo-HSCT outcomes after CAR-T therapy versus chemotherapy in pediatric patients with relapsed/refractory B-ALL: a retrospective study

Chi-Kong LI, Xiaoyan Wu, 何光翠, J R Chen, Jiaoyang Cai, H Z Wang, 潘凯丽, X Liu, Bohan Li, Jingbo Wang, Yiping Zhu, Hua Jiang, Chengjuan Luo, X Y Xiao, Y F Cheng, Y Guo, Ruijuan Sun, Xiaohang Huang, Maoquan Qin, Liping Wan, Shaoyan Hu, Aiguo Liu, Jing Pan, Kai Chen, Xiaoqin Feng, Jie Yu, Zimin Sun, Peifang Xiao, Jing Lu, Jun Lu
article en

Abstract

BACKGROUND: Hematopoietic stem cell transplantation (HSCT) is a curable treatment for refractory/relapse B-cell acute lymphoblastic leukemia (R/R B-ALL).Traditional chemotherapy or Chimeric antigen receptor T-cell (CAR-T) therapy are both important methods to achieve MRD negativity before HSCT. However, which treatment is preferred needs to be clarified. PATIENTS AND METHODS: In this study, 269. PATIENT: s with R/R B-ALL who underwent allo-HSCT after CAR-T cell therapy (CAR-T, n = 142) or chemotherapy (CT, n = 127) were enrolled from multicenters. RESULTS: The 3-year overall survival (OS) after transplantation was 66.8% in the CAR-T group and 72.3% in the chemotherapy (CT) group. The 3-year relapse-free survival (RFS) was 65.3% in the CAR-T group and 65.9% in the CT group. The 3-year graft-versus-host disease, relapse-free survival (GRFS) and cumulative incidence of relapse (CIR) were also similar between the two groups. Among patients who achieved first complete remission (CR1) before transplantation, the proportion receiving chemotherapy was significantly higher than that receiving CAR-T therapy (37.5% vs. 13.6%; P < 0.001). In this CR1 subgroup, the CT group demonstrated superior outcomes, including improved OS, RFS, and GRFS. CONCLUSION: In pediatric R/R B-ALL, CAR-T bridging to HSCT appears to yield post-transplant survival comparable to chemotherapy, though a higher rate of moderate to severe chronic GVHD was observed. CAR-T may be a reasonable option, but closer GVHD monitoring seems warranted.

The Oncologist
University of Science and Technology of China (CN), Chinese University of Hong Kong (HK), Shanghai Jiao Tong University (CN), Chinese Academy of Medical Sciences & Peking Union Medical College (CN), Peking University (CN), Sichuan University (CN), Tianjin First Center Hospital (CN), Shandong Normal University (CN), Soochow University (CN), Shanghai Children's Medical Center (CN), Northwest Women's and Children's Hospital (CN), Chengdu Military General Hospital (CN), 302 Military Hospital of China (CN), Guangzhou Women and Children Medical Center (CN), Aerospace Center Hospital (CN), Peking University People's Hospital (CN), Wuhan Union Hospital (CN), Luye Pharma (China) (CN), Beijing Children’s Hospital (CN), Institute of Hematology & Blood Diseases Hospital (CN), First Affiliated Hospital of Soochow University (CN), Shanghai Children's Hospital (CN), Children's Hospital of Chongqing Medical University (CN), Tongji Hospital (CN), Huazhong University of Science and Technology (CN), Tianjin Medical University (CN), Southern Medical University (CN), Chongqing Medical University (CN), Guangzhou Medical University (CN)
Good health and well-being
Openalex Percentile: Top 7%
Acute Lymphoblastic Leukemia research
DOIOpen Access PDFOpenAlex
AI Navigator

Ask Laika to Summarize, Analyze, and Connect papers live on the map.

Summarize Papers & Methodologies

Extract key findings, datasets, and comparative methods across publications.

Benchmark Rankings & Visual Analytics

Rank top research institutions, authors, funders, topics, and journals by Field-Weighted Citation Impact (FWCI) and paper volume with instant charts.

Connect Distant Disciplines

Bridge topological clusters on the map to find hidden collaborative intersections.