Hematology · Oncology · 2 h ago
Apheresis blasts linked to survival after tisagenlecleucel in young patients with B-ALL
A retrospective, multi-institutional cohort study of 162 children and young adults with relapsed or refractory B-ALL assessed peripheral blasts at apheresis before CD19 CAR T-cell therapy. Blasts were associated with lower 12-month survival, but the association was influenced by disease burden at infusion and was not significant for death in multivariable analysis.
- Day-28 response was comparable between blast groups.
- Twelve-month EFS and OS were lower with apheresis blasts.
- Blast percentage was not independently associated with death.
Researchers retrospectively analyzed 162 children and young adults with relapsed or refractory B-cell acute lymphoblastic leukemia treated with CD19-specific CAR T-cell therapy in the Pediatric Real-World CAR Consortium. They compared outcomes according to whether peripheral blasts were present at apheresis, including day-28 response, event-free survival (EFS) and overall survival (OS).
Day-28 response was comparable between groups. At 12 months, EFS was 27% among patients with peripheral blasts at apheresis versus 55% among those without; OS was 55% versus 78%, respectively. However, the survival association was confounded by disease burden at the time of infusion. In multivariable analysis, higher blast percentage at apheresis was not associated with a significantly increased hazard of death (HR 1.11; 95% CI 0.93–1.33; P = .25).
The findings suggest that apheresis blast status may reflect subsequent disease burden rather than independently predict survival. The retrospective design and reported confounding limit interpretation; the results do not establish that apheresis blast status should change treatment decisions.
In practice
For children and young adults with relapsed or refractory B-ALL receiving CD19 CAR T-cell therapy, peripheral blasts at apheresis were associated with lower 12-month EFS and OS in this retrospective cohort. However, the association was influenced by disease burden at infusion, and higher apheresis blast percentage was not significantly associated with death in multivariable analysis. These findings may inform prognostic discussions but do not establish an independent risk marker or support changing treatment decisions based on apheresis blast status alone.
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Blood Advances: Peripheral blasts at apheresis as a risk factor for survival after tisagenlecleucel in children and young adults ↗This is an automated AI-condensed summary that has not yet been reviewed by an editor. Always consult the full item at the original source.