{
  "abstract": "BackgroundWhether allogeneic hematopoietic stem cell transplantation (HSCT) is required after chimeric antigen receptor T-cell (CAR-T)–induced remission in pediatric relapsed/refractory B-cell acute lymphoblastic leukemia (R/R B-ALL) remains unresolved. We report single-center outcomes of CAR-T therapy with or without subsequent HSCT, evaluated using current consensus response criteria.MethodsThis single-center retrospective cohort study included 34 pediatric patients with R/R B-ALL who received investigational autologous CAR-T products (CD28- or 4-1BB–based; single- or dual-target) between June 2018 and December 2023. Response was assessed per National Comprehensive Cancer Network guidelines and international consensus definitions; survival by Kaplan–Meier estimation. The HSCT comparison was descriptive, complemented by a 6-month landmark analysis, a time-dependent Cox analysis restricted to patients transplanted at our center, and event-free survival (EFS) with in-remission HSCT censored at transplant.ResultsMedian age was 7.3 years; 26 patients were relapsed and 8 refractory. CR or CRi (CR/CRi) was achieved in 26/34 (76.5%), all MRD-negative. Grade ≥3 CRS occurred in 11.8% and grade 3 ICANS in 2.9%. At a median follow-up of 21.4 months, 2-year OS and EFS were 57.4% (95% CI, 38.8–72.3) and 43.2% (26.2–59.1). Among 24 patients with marrow-involved disease achieving MRD-negative CR, 20 underwent HSCT and 4 did not; 2-year OS was 79.3% versus 25.0% (descriptive log-rank P = 0.006), and all 4 non-HSCT patients relapsed and died. In the 6-month landmark analysis (n=21), HSCT by landmark remained associated with superior OS (P = 0.047); the time-dependent Cox analysis showed a consistent association (OS: HR, 0.19 (0.04–0.90); P = 0.036). With in-remission HSCT censored, no patient remained event-free beyond 12.1 months, versus a conventional 2-year EFS of 61.8%. Two of 4 patients with isolated testicular relapse achieved durable remission without HSCT.ConclusionsCAR-T therapy induced high rates of MRD-negative remission with manageable toxicity in pediatric R/R B-ALL, but rarely produced durable survival without HSCT in marrow-involved disease. Post-remission HSCT was associated with improved survival; salvage HSCT after relapse also appeared effective in a few patients. These associations are limited by the retrospective design and small sample size and require prospective confirmation.",
  "abstract_shown": true,
  "affiliations": [],
  "article_type": "Original Research",
  "arxiv": null,
  "author_total": 10,
  "authors": [
    {
      "name": "Ziwei Liao"
    },
    {
      "name": "Feimei Kuang"
    },
    {
      "name": "Yuxuan Luo"
    },
    {
      "name": "Jiayi Wang"
    },
    {
      "name": "Wenge Hao"
    },
    {
      "name": "Qingqing Zheng"
    },
    {
      "name": "Huiling Lin"
    },
    {
      "name": "Pengfei Wang"
    },
    {
      "name": "Hua Jiang"
    },
    {
      "name": "Weina Zhang"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/7sg8cw3dgss3r.bib",
  "cited_by": 0,
  "doi": "10.3389/fonc.2026.1866852",
  "fulltext_url": null,
  "id": "7sg8cw3dgss3r",
  "issns": [
    "2234-943X"
  ],
  "landing_url": "https://www.frontiersin.org/articles/10.3389/fonc.2026.1866852",
  "language": null,
  "licence": "CC-BY-4.0",
  "licence_label": "CC BY 4.0",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "feed-journal",
      "medicine/oncology"
    ]
  ],
  "openalex": null,
  "pdf_url": null,
  "pmcid": null,
  "pmid": null,
  "published": "2026-11-06",
  "publisher": "Frontiers Media SA",
  "ris": "https://research.draconitic.com/paper/7sg8cw3dgss3r.ris",
  "sources": [
    {
      "first_seen": "2026-11-06T12:20:48Z",
      "native_id": "10.3389/fonc.2026.1866852",
      "source": "feed-frontiers",
      "url": "https://www.frontiersin.org/articles/10.3389/fonc.2026.1866852"
    },
    {
      "first_seen": "2026-11-06T12:21:22Z",
      "native_id": "10.3389/fonc.2026.1866852",
      "source": "crossref",
      "url": "https://www.frontiersin.org/articles/10.3389/fonc.2026.1866852/full"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "feed-journal:medicine/oncology",
      "subfield": "oncology"
    }
  ],
  "title": "Impact of consolidative HSCT after CAR T-cell–induced remission in pediatric relapsed/refractory B-ALL: a single-center retrospective cohort",
  "title_text": "Impact of consolidative HSCT after CAR T-cell–induced remission in pediatric relapsed/refractory B-ALL: a single-center retrospective cohort",
  "type": "peer-reviewed",
  "updated_at": "2026-11-08T00:23:06Z",
  "url": "https://research.draconitic.com/paper/7sg8cw3dgss3r",
  "venue": "Frontiers in Oncology",
  "versions": []
}