CAR-T cell therapy in T-Cell lymphoblastic leukemia/lymphoma: where do we stand now?

Introduction: CAR-T therapies for relapsed or refractory (r/r) T-cell lymphoblastic leukemia/lymphoma (T-LL/L) faces challenges, with most clinical studies conducted in small, dispersed cohorts and often reviewed alongside preclinical studies. This review focuses exclusively on clinical studies, evaluating CAR constructs, safety and efficacy.

Methods: A systematic review was conducted of databases, clinical trial registries, and abstracts from conferences (June 2014 to June 2024). Preclinical studies and studies lacking clinical details were excluded. Data on patient demographics, CAR-T characteristics, response rates, survival, and adverse events were analyzed.

Results: Eleven CAR-T constructs targeting CD7 and two targeting CD5 were identified. Complete remission (CR/CRi) rates ranged from 55% to 100%, exceeding 80% in most studies. Relapse, often in extramedullary sites, ranged from 7% to 66%. Cytokine release syndrome and neurotoxicity were generally manageable. GVHD incidence varied (none to 60%), primarily in allogeneic CAR-T recipients. Infections contributed to 6-38% of treatment-related mortality.

Conclusions: CAR-T therapy achieves high response rates in r/r T-LL/L and may serve as a bridge to allogeneic transplantation. However, the short follow-up and the duration of responses remain concerns, and challenges endure, including GVHD, immune recovery and infection control. Standardized reporting is crucial to optimize therapy outcomes and safety in future trials.

Registration: PROSPERO (CRD420251024662).