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Relapse or failure to respond after CD19-targeted CAR T-cell therapy
Source: Childhood Acute Lymphoblastic Leukemia Treatment (PDQ®)–Health Professional Version, National Cancer Institute.
Source updated: April 21, 2025 · Captured 2026-09-09.
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Retrospective studies have described outcomes and assessed factors associated with survival after relapse in patients who received CD19-targeted CAR T-cell therapy:
A study looked at 166 relapses occurring after CAR T-cell therapy using either 4-1BB or CD28 costimulatory domains.[196]
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A study looked at 166 relapses occurring after CAR T-cell therapy using either 4-1BB or CD28 costimulatory domains.[196]
Eighty-three patients (50%) were CD19 positive, 68 (41%) were CD19 negative, and 12 (7.2%) had lineage switch relapses.
A study looked at 166 relapses occurring after CAR T-cell therapy using either 4-1BB or CD28 costimulatory domains.[196]
The median OS was 11.9 months (95% CI, 9–17 months), with no difference between CD19-positive and CD19-negative relapses.
A study looked at 166 relapses occurring after CAR T-cell therapy using either 4-1BB or CD28 costimulatory domains.[196]
Patients with lineage switch relapses had a dismal prognosis, with no long-term survivors.
A study looked at 166 relapses occurring after CAR T-cell therapy using either 4-1BB or CD28 costimulatory domains.[196]
CD19-positive relapses were associated with a greater prior treatment burden, shown by a greater number of previous remissions.
A study looked at 166 relapses occurring after CAR T-cell therapy using either 4-1BB or CD28 costimulatory domains.[196]
CD19-negative relapses were associated with a greater pre-CAR T-cell infusion disease burden, prior nonresponse to blinatumomab, older age, and a 4-1BB costimulatory domain.
A study looked at 166 relapses occurring after CAR T-cell therapy using either 4-1BB or CD28 costimulatory domains.[196]
Lineage switch relapses were associated with the presence of KMT2A rearrangements.
A second study reviewed 80 patients (27 nonresponders and 53 who relapsed) who received 4-1BB-based CD19-targeted CAR T-cell therapy that failed to produce remissions.[197]
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A second study reviewed 80 patients (27 nonresponders and 53 who relapsed) who received 4-1BB-based CD19-targeted CAR T-cell therapy that failed to produce remissions.[197]
Of the nonresponders, 95% had high disease burden (>5% blasts) before CAR T-cell infusion.
A second study reviewed 80 patients (27 nonresponders and 53 who relapsed) who received 4-1BB-based CD19-targeted CAR T-cell therapy that failed to produce remissions.[197]
CD19-negative relapses were associated with a decreased OS rate at 1 year, compared with CD19-positive relapses (30% [95% CI, 14%–66%] vs. 68% [49%–92%]; P = .0068).
A second study reviewed 80 patients (27 nonresponders and 53 who relapsed) who received 4-1BB-based CD19-targeted CAR T-cell therapy that failed to produce remissions.[197]
Only treatment followed by HSCT if remission was obtained was associated with long-term survival.
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