与化疗相比，CAR-T 细胞治疗后异基因造血干细胞移植的血小板植入失败与慢性移植物抗宿主病风险更高：一项倾向性评分匹配分析

Allogeneic haematopoietic stem cell transplantation (allo-HSCT) has been reported to further sustain long-term leukaemia-free survival following chimeric antigen receptor T-cell (CAR-T) therapy. It remains unclear whether bridging CAR-T to allo-HSCT results in higher treatment-related toxicity and mortality.

We conducted a retrospective study to compare outcomes between allo-HSCT after CAR-T or conventional chemotherapy. After propensity score matching, 62 patients with prior CAR-T therapy and 124 patients with chemotherapy were ultimately included. Patients in the CAR-T cohort had a longer duration time from diagnosis to transplant (p < 0. 001) and more advanced disease status before HSCT (p < 0. 001) than that of the chemotherapy cohort. Patients with prior CAR-T cell therapy had a lower 28-day platelet engraftment rates [Hazard Rate (HR) = 1. 38, 95% Confidence Interval (CI), 1. 02-1. 87, p = 0. 037].

Multivariate analysis revealed that CAR-T therapy increased the risk of moderate to severe chronic graft-versus-host disease (cGVHD) (HR = 2. 5, 95% CI, 1. 01-6. 19, p = 0. 048). Compared with patients in the chemotherapy cohort, those in the CAR-T cell cohort experienced a higher incidence of transplantation-associated thrombotic microangiopathy (6.

5% vs. 0. 8%, p = 0. 03) and probable/possible invasive fungal disease (10. 0% vs. 3. 3%, p = 0. 08). The relapse rate, non-relapse mortality, and survival were comparable between cohorts. Caution should be exercised in allo-HSCT following CAR-T therapy because of the higher risk of platelet engraftment failure and cGVHD compared to chemotherapy.