Outcomes of patients with R/R cortical CD1a+ T‑cell ALL: A Spanish multicenter experience

Results from a retrospective, observational, multicenter, Spanish cohort study, evaluating outcomes of pediatric (n = 15) and adult (n = 28) patients with relapsed/refractory (R/R) cortical CD1a+ T‑cell acute lymphoblastic leukemia (ALL) before the introduction of CD1a-directed chimeric antigen receptor (CAR) T‑cell therapy, were published in Annals of Hematology by Rivera-Pérez et al. The primary endpoint was overall survival (OS). 

Key data: With a median follow-up of 7.0 years, 14.0% of patients were alive and in complete remission (CR), while 86.0% of patients died during follow-up; median OS was 7.3 months (95% confidence interval [CI], 4.4–8.2) and 5-year OS was 16% (95% CI, 7–29). The main cause of death was disease progression (78.4%), followed by transplant-related mortality (18.9%). Among 29 patients considered eligible for CD1a-directed CAR T-cell therapy, median OS was 7.5 months (95% CI, 4.5–8.2) and 5-year OS was 7% (95% CI, 1–20). In multivariable analysis, bone marrow relapse (hazard ratio [HR], 3.20; 95% CI, 1.34–7.66), <12 months from first CR to relapse (HR, 2.15; 95% CI, 1.04–4.46), and no allogeneic hematopoietic stem cell transplantation (allo-HSCT) during salvage treatment (HR, 3.80; 95% CI, 1.23–11.75) were associated with worse OS. 

Key learning: This real-world Spanish experience underscores the poor outcomes of pediatric and adult patients with R/R cortical CD1a+ T‑cell ALL, highlighting the need for continued evaluation of alternative therapeutic strategies in this challenging setting.