Circulating tumor DNA for prognosis in hematologic malignancies receiving immune checkpoint inhibitors or chimeric antigen receptor T-cell therapy: a systematic review and meta-analysis
Abstract
ObjectiveCirculating tumor DNA (ctDNA) is an emerging biomarker in hematologic malignancies, and elevated ctDNA levels may reflect higher tumor burden. Its prognostic significance in patients undergoing chimeric antigen receptor T-cell (CAR-T) therapy or immune checkpoint inhibitors (ICIs) remains debatable. The purpose of this meta-analysis and comprehensive review was to clarify the prognostic importance of ctDNA in this patient population.MethodsWe initially searched PubMed, Embase, Scopus, Web of Science, and the Cochrane Library up to May 2026 and updated the search in September 2026. We methodically assessed the association between ctDNA levels and important survival outcomes using a random-effects model. Study quality was assessed using the Quality in Prognosis Studies (QUIPS) tool.ResultsNine studies involving 484 patients with hematologic malignancies were included. Across seven studies involving 406 patients, high pretreatment ctDNA levels were associated with poorer PFS, with a pooled HR of 1.96 (95% CI: 1.32, 2.90). Five studies involving 279 patients showed an association with poorer OS, with an HR of 3.51 (95% CI: 2.01, 6.11). Unfavorable versus favorable posttreatment ctDNA status was associated with poorer PFS across seven studies involving 301 patients, with an HR of 4.01 (95% CI: 2.68, 6.01), and poorer OS across five studies involving 209 patients, with an HR of 3.19 (95% CI: 1.82, 5.57). Sensitivity analyses confirmed the robustness of the pooled results.ConclusionHigh pretreatment ctDNA levels and unfavorable posttreatment ctDNA status were associated with poorer PFS and OS in patients with HMs receiving ICIs or CAR-T therapy. These findings support ctDNA as a potential prognostic biomarker for risk stratification and response monitoring, while the clinical benefit of management guided by ctDNA requires prospective validation.
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BibTeX
@article{wang2026circulating,
title = {{Circulating tumor DNA for prognosis in hematologic malignancies receiving immune checkpoint inhibitors or chimeric antigen receptor T-cell therapy: a systematic review and meta-analysis}},
author = {Congcong Wang and Zhibing Jiang and Jiaojiao Qiao and Jie Ma and Yuru Wang and Lihua Xu and Shuangli He and Xue Liang},
journal = {Frontiers in Immunology},
year = {2026},
month = nov,
doi = {10.3389/fimmu.2026.1939135},
url = {https://www.frontiersin.org/articles/10.3389/fimmu.2026.1939135},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Circulating tumor DNA for prognosis in hematologic malignancies receiving immune checkpoint inhibitors or chimeric antigen receptor T-cell therapy: a systematic review and meta-analysis
AU - Congcong Wang
AU - Zhibing Jiang
AU - Jiaojiao Qiao
AU - Jie Ma
AU - Yuru Wang
AU - Lihua Xu
AU - Shuangli He
AU - Xue Liang
PY - 2026
DA - 2026/11/06
JO - Frontiers in Immunology
DO - 10.3389/fimmu.2026.1939135
UR - https://www.frontiersin.org/articles/10.3389/fimmu.2026.1939135
AB - ObjectiveCirculating tumor DNA (ctDNA) is an emerging biomarker in hematologic malignancies, and elevated ctDNA levels may reflect higher tumor burden. Its prognostic significance in patients undergoing chimeric antigen receptor T-cell (CAR-T) therapy or immune checkpoint inhibitors (ICIs) remains debatable. The purpose of this meta-analysis and comprehensive review was to clarify the prognostic importance of ctDNA in this patient population.MethodsWe initially searched PubMed, Embase, Scopus, Web of Science, and the Cochrane Library up to May 2026 and updated the search in September 2026. We methodically assessed the association between ctDNA levels and important survival outcomes using a random-effects model. Study quality was assessed using the Quality in Prognosis Studies (QUIPS) tool.ResultsNine studies involving 484 patients with hematologic malignancies were included. Across seven studies involving 406 patients, high pretreatment ctDNA levels were associated with poorer PFS, with a pooled HR of 1.96 (95% CI: 1.32, 2.90). Five studies involving 279 patients showed an association with poorer OS, with an HR of 3.51 (95% CI: 2.01, 6.11). Unfavorable versus favorable posttreatment ctDNA status was associated with poorer PFS across seven studies involving 301 patients, with an HR of 4.01 (95% CI: 2.68, 6.01), and poorer OS across five studies involving 209 patients, with an HR of 3.19 (95% CI: 1.82, 5.57). Sensitivity analyses confirmed the robustness of the pooled results.ConclusionHigh pretreatment ctDNA levels and unfavorable posttreatment ctDNA status were associated with poorer PFS and OS in patients with HMs receiving ICIs or CAR-T therapy. These findings support ctDNA as a potential prognostic biomarker for risk stratification and response monitoring, while the clinical benefit of management guided by ctDNA requires prospective validation.
SN - 1664-3224
ER -