Optimizing Allogeneic Stem Cell Transplantation Following CAR-T Therapy in Acute Lymphoblastic Leukemia

Background and Aim: Patients with B-cell acute lymphoblastic leukemia (B-ALL) who are refractory or relapsed (R/R) have few therapeutic options and a poor prognosis.Chimeric antigen receptor (CAR) T-cell therapy represents a significant advancement in contemporary cell and gene therapies, bridging the gap in the treatment of high-risk patients and linking immunotherapies with cancer treatments, particularly in hematologic malignancies.This review examines the clinical evidence supporting consolidative allogeneic hematopoietic stem cell transplantation (ALLO-HSCT) following CAR T-cell therapy, as well as the variables that may affect the effectiveness of ALLO-HSCT.Finally, we offer suggestions for evaluating and treating patients with R/R, B-ALL who are receiving CAR T-cell therapy.Materials and Methods: International databases, including PubMed, Google Scholar, Scopus, and ISI, as well as national databases, such as Magiran, SID, and IranMedex, were utilized to obtain the articles used in this study.The search terms included CAR-T cells, hematopoietic stem cell transplantation, acute lymphoblastic leukemia, and relapse.Results: According to numerous clinical investigations, complete remission (CR) rates of 70-90% can be achieved with CAR T-cell treatment.It is crucial to understand that remission induced by CAR T-cell therapy may not last forever.According to research, between 30% and 60% of individuals may relapse following treatment. Conclusion:Therefore, researchers are now questioning the necessity of consolidative ALLO-HSCT in light of the successful remissions achieved by CAR T-cell therapy.Due to a lack of reliable information, the role of CAR T-cell treatment as a temporary solution or a permanent remedy before ALLO-HSCT remains a topic of debate.