预测 B 细胞急性淋巴细胞白血病 CAR-T 细胞治疗结局的生物标志物：系统综述

Following PRISMA guidelines, we systematically searched PubMed, Web of Science, and Embase for studies published between 2018-2024. A total of 33 studies involving 2,095 patients were included in the analysis.

Key findings identified tumor burden and minimal residual disease (MRD) as dual-predictive biomarkers. High tumor burden ( 40% blasts) correlated with reduced complete remission rates (87% vs. 100%) and increased CRS/ICANS risks, while MRD negativity (NGS threshold <10 ) predicted superior 2-year event-free survival (68% vs. 23%). CAR-T functional parameters, including PD-1/LAG-3 expression (>5.2% in CD4+ cells) and peak expansion kinetics, linked efficacy to toxicity trade-offs. Genetic biomarkers (IKZF1 mutations, complex karyotypes) and biochemical indicators (m-EASIX >6.2, ferritin 10,000 ng/mL) further stratified risks. Unidirectional efficacy biomarkers included T-cell subsets (e.g., CD8+ naive T cells) and B-cell aplasia, while IL-6 dynamics specifically predicted CRS severity. DISCUSSION: Despite promising insights, heterogeneity in toxicity grading systems, inconsistent biomarker thresholds, and retrospective study designs limit clinical standardization. Future directions emphasize cytoreductive bridging therapies, biomarker-guided combinatorial approaches (e.g., MDM2 inhibitors for TP53 mutations), and multicenter validation of integrated predictive models to optimize personalized CAR-T therapy strategies.