The New England Journal of MedicineSequential CD7 CAR T-Cell Therapy and Allogeneic HSCT without GVHD Prophylaxis

Evaluating the Efficacy of Sequential CD7 CAR T-cell Therapy and Haploidentical HSCT in Hematologic Cancers

In the ongoing pursuit to improve outcomes for patients with relapsed or refractory hematologic cancers, a novel therapeutic approach combines chimeric antigen receptor (CAR) T-cell therapy with haploidentical hematopoietic stem-cell transplantation (HSCT). This study explores the efficacy and safety of this integrated strategy, aiming to sustain CAR T-cell function and enhance tumor control without the use of traditional myeloablative and graft-versus-host disease prophylaxis agents.

Study Design:

• Population: 10 patients with relapsed or refractory CD7-positive leukemia or lymphoma.
• Intervention: Sequential treatment consisting of CD7 CAR T-cell therapy followed by haploidentical HSCT, without pharmacologic myeloablation or GVHD prophylaxis.
• Monitoring: Assessment of toxic effects and efficacy with a follow-up period ranging from 3.1 to 24.0 months.

Key Findings:

• Remission Status: All patients achieved complete remission post CAR T-cell therapy but exhibited incomplete hematologic recovery and grade 4 pancytopenia.
• Post-Transplant Outcomes: One patient deceased due to septic shock, 8 achieved full donor chimerism, and 1 reverted to autologous hematopoiesis.
• Complications: Three patients experienced grade 2 acute GVHD post-HSCT.
• Survival Rates: Estimated 1-year overall survival was 68% and disease-free survival was 54%.

HCN Medical Memo
The integrated use of CD7 CAR T-cell therapy and haploidentical HSCT presents a promising alternative for patients with advanced hematologic malignancies, particularly those ineligible for conventional treatments. This approach, emphasizing a reduction in traditional toxicities while maintaining efficacy, underscores the potential for refining treatment protocols in complex cancer therapies.

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