The Use of CAR-T Immunotherapy in the Treatment of Acute Lymphoblastic Leukemia: A Systematic Literature Review with Meta-Analysis

Background: The objective of this study was to evaluate the efficacy and safety of CAR-T immunotherapy in inducing remission in patients with Acute Lymphoblastic Leukemia (ALL). Methods: The search strategy was conducted in the BVS, Embase, PubMed, and ScienceDirect databases, where 4138 studies were initially identified. Results: The final analysis resulted in the inclusion of 35 studies, all of which were incorporated into the meta-analysis, covering a cohort of 1313 patients. Statistical analysis was performed using R software (version 4.5.2), revealing a Complete Remission rate of 70.68% and a Minimal Residual Disease negativity rate of 76.68%. Tactical superiority was observed in the second-generation cells and in the dual CD19/CD22 target (82.20% CR). The risk of bias assessment using the ROBINS-I tool indicated high quality for most of the studies. The certainty of evidence according to the GRADE system was classified as moderate. Adverse events such as cytokine release syndrome (46.81%) and neurotoxicity (23.52%) were frequent but reversible. Conclusions: We thus observe that CAR-T therapy is an effective strategic bridge to bone marrow transplantation, with advances in cell persistence being fundamental for sustained cure.