Efficacy And Safety Of CD19 CAR-T Cells In Refractory/Recurrent Acute B-Lymphoblastic Leukemia:A Meta-analysis

Objective:This meta-analysis was conducted to systematically evaluate the efficacy and safety of CD19 chimeric antigen receptor T(CAR-T)cell therapy in refractory/recurrent acute Blymphoblastic leukemia(r/r B-ALL).Methods:PubMed,Cochrane Library,EMbase and other databases were retrieved to collect cohort studies on CD19CAR-T cell therapy for r/r B-ALL,and the retrieval time is from 2000 to December 2018.Data extraction and quality evaluation were carried out for the documents that met the inclusion criteria.Meta analysis was carried out using R3.5.1 software.The indicators included :1.the overall response rate(ORR);2.The safety indicators included the incidence of sCRS(≥ grade 3 CRS)and the relapse rate.Results:Twelve cohort studies were included.Meta-analysis showed that the overall response rate(ORR)of CD19CAR-T was 81% [95% CI(0.73,0.87)],the rate of sCRS was 26% [95% CI(0.21,0.32)],and the relapse rate was 33% [95% CI(0.27,0.40)].Conclusion :CD19CAR-T has a better clinical response rate,lower severe adverse reaction rate and recurrence rate in the treatment of r/r B-ALL.The source of CAR-T cells,the proportion of primordial cells in bone marrow before treatment and whether or not to accept hematopoietic stem cell transplantation are important impacts on the overall response rate.However,due to the limitations of the quantity and quality of the literature,more higher quality studies are needed to verify the above conclusions.