Bridging transplantation and immunotherapy: Clinical promise of autologous stem cell transplantation with chimeric antigen receptor T-cell therapy.

Abstract

Autologous stem cell transplantation (ASCT) and chimeric antigen receptor T-cell (CAR-T) therapy represent pivotal treatments for hematologic malignancies, each with distinct strengths and limitations. ASCT reduces tumor burden through myeloablative conditioning but remains susceptible to relapse, while CAR-T therapy precisely targets malignant cells but encounters challenges, including cytokine release syndrome (CRS), immune effector cell-associated neurotoxicity syndrome (ICANS), and limited persistence. Emerging evidence suggests that combining ASCT with CAR-T therapy yields synergistic effects. ASCT reshapes the immune microenvironment, lowers immunosuppressive cells and CRS risk, while CAR-T eliminates residual disease and promotes immune recovery. Clinical trials in relapsed/refractory B-cell lymphomas and multiple myeloma demonstrate complete remission rates (CRR) of 72%-100% and two-year progression-free survival (PFS) rates of 59%-83%, with severe CRS/ICANS incidences below 10%. However, the precise mechanisms underlying this synergy, optimal timing of CAR-T infusion after ASCT, and ideal dosing regimens require further definition. Future research should prioritize large-scale, randomized controlled trials and establish standardized protocols for toxicity management to maximize therapeutic benefits. By integrating the complementary strengths of ASCT and CAR-T, this combination strategy represents a promising approach for improving outcomes in high-risk hematologic malignancies; however, additional studies are necessary to validate its efficacy and expand its clinical applicability.