ArticleFrontiers in immunology2026
CAR-T versus allogeneic transplantation as consolidation for B-cell acute lymphoblastic leukemia in remission: a propensity-score matched study.
Article in Frontiers in immunology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Despite being a standard consolidation treatment, allogeneic hematopoietic stem cell transplantation (allo-HSCT) for B-cell acute lymphoblastic leukemia (B-ALL) in remission is still hampered by relapse and complications. While CAR-T therapy is revolutionizing later-line treatment, its role as a consolidation strategy in remission, particularly for patients ineligible for transplantation, remains unexplored. This study compared the efficacy of CAR-T therapy with that of allo-HSCT as consolidation for B-ALL patients in complete remission (CR). Methods: A retrospective, propensity-score matched study was performed from September 1, 2012 to December 31, 2024, including 75 B-ALL patients treated with CAR-T or allo-HSCT as consolidation therapy. Firth penalized likelihood Cox models and restricted mean survival time (RMST) models were built for time-to-event outcomes. Results: The 2-year progression-free survival (PFS) and 2-year overall survival (OS) rates showed no significant differences between the CAR-T and HSCT cohorts (CR1: 2-year PFS rate: 65.8% vs. 88.9%, P = 0.146, 2-year OS rate: 83.6% vs. 91.3%, P = 0.512; CR2: 2-year PFS rate: 42.2% vs. 64.3%, P = 0.360). The RMSTs of PFS and OS also have no significant differences (CR1: RMST of PFS difference = -7.738, P = 0.496, RMST of OS difference = -2.257, P = 0.788; CR2: RMST of PFS difference = -6.176, P = 0.700, RMST of OS difference = -8.391, P = 0.477) truncated at the minimum of the largest follow-up times in each cohort (CR1, 74.6 months; CR2, 75.0 months). In multivariate analysis, patients treated with allo-HSCT had better PFS in CR1 group (HR = 4.579, 95%CI, 1.020-20.563, P = 0.038). High risk stratification was an independent factor associated with worse OS for B-ALL patients in CR (CR1: HR = 8.010; 95%CI, 1.744-36.781, P = 0.048; CR2 HR = 5.110, 95%CI, 1.167-22.378, P = 0.004). Conclusion: The results indicated that CAR-T consolidation regimen showed comparable survival to that of allo-HSCT in matched B-ALL patients, which might support its potential as a consolidation alternative for B-ALL patients ineligible for allo-HSCT.
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