Safety and efficacy of CD19-targeted CAR-T-cell therapy for patients with relapsed or refractory TCF3-PBX1 fusion gene-positive B-ALL

Abstract

Background: Chimeric antigen receptor (CAR)-T therapy has shown significant success in the treatment of relapsed or refractory acute lymphoblastic leukemia (r/r ALL). However, its role in patients with the TCF3-PBX1 fusion gene–which generally exhibit poor prognostic indicators–remains uncertain. Patients and methods: From September 2016 to March 2023, 7 patients with r/r ALL positive for the TCF3-PBX1 fusion gene underwent CD19 CAR-T-cell therapy at the First Affiliated Hospital of Zhejiang University School of Medicine. The safety and efficacy of the treatment were evaluated. Results: Four of the 7 patients experienced CAR-T-cell expansion in vivo, with a median peak percentage of CD3+ T-cell expansion of 64.9% (range: 29.1–78.1%). These 4 patients experienced grade 1 cytokine release syndrome. For the efficacy assessment, 4 patients with CAR-T-cell expansion achieved complete remission (CR), whereas the other 3 did not respond and ultimately died of disease progression. Among the 4 patients who achieved CR, 1 patient with a history of allogeneic stem cell transplantation (allo-HSCT) did not bridge to secondary allo-HSCT and relapsed 7 months after CAR-T-cell infusion. The other 3 CR patients successfully bridged to allo-HSCT; however, 2 of them relapsed post-allo-HSCT. One of the relapsed patients achieved remission after receiving donor-derived CAR-T-cell infusion and has maintained CR to date. Another patient died of disease progression. The remaining patient has achieved sustained remission to date. Conclusion: Our study indicates that CD19 CAR-T therapy is safe and effective in TCF3-PBX1-positive r/r B-ALL. Further studies in larger cohorts are warranted to confirm these observations.