Jing Pan, Yue Tan, Biping Deng, Chunrong Tong, Lin Hua, Zhuojun Ling, Weiliang Song, Jinlong Xu, Jiajia Duan, Zelin Wang, Huilin Guo, Xinjian Yu, Alex H. Chang, Qinlong Zheng & Xiaoming Feng

To the Editor:

Despite high remission rates after CD19 CAR T-cell therapy in patients with refractory or relapsed B acute lymphoblastic leukemia (r/r B-ALL), relapses were commonly observed. To improve long-term disease-free survival (DFS), our and other centers have conducted post-CD19 CAR consolidations with allogeneic hematopoietic stem cell transplantation (allo-HCT) or CD22 CAR T-cell infusion. However, some patients still relapsed, but it is unknown which factors caused their relapses. TP53 mutation predicts nonresponse and poor outcome in childhood B-ALL during traditional therapies. Genomic instability caused by TP53 mutation induces leukemia cells to undergo genomic evolution to survive stress and treatment. In our previous studies, CAR T therapy can overcome genetic adverse features including TP53 mutation to induce remission, but it is unknown whether the long-term outcome would be influenced by TP53 mutation and other genetic aberrations.

Refer to the original: https://doi.org/10.1038/s41375-020-0831-z