Acute Lymphoblastic Leukemia(T-ALL)-04

The patient was a 15-year-old male, diagnosed with T-cell acute lymphoblastic leukaemia (T-ALL with STIL-TAL1 positivity, a poor prognostic gene) at the end of December 2020, and was treated in a local hospital with multiple cycles of regular chemotherapy to achieve complete remission. A father-to-son hemizygous haematopoietic stem cell transplantation was performed on 2 June 2021, but unfortunately a bone marrow relapse was detected in 3 months after the transplantation, and 1 cycle of chemotherapy was ineffective. At the same time, he developed bulging cheeks and leakage of air, crooked corners of the mouth, and a lumbar puncture suggested the development of central nervous system leukaemia.

T-ALL with STIL-TAL1 positivity, early relapse after allogeneic transplantation, combined with central nervous system leukaemia, is a very difficult case to treat in the era without CAR-T. The child's father inquired about the hematology department at Tianjin Cancer Hospital Airport Hospital through his friends. After detailed communication, they came to Tianjin Cancer Hospital Airport Hospital, seeking to enroll in a CAR-T clinical trial as a last effort.

The first CAR-T failed Tumor cells multiplied rapidly, endangering his life.

On 26 October 2021, the patient was admitted to the first ward of the Department of Hematology. Due to the rapid proliferation of tumor cells, the patient underwent chemotherapy to reduce tumor load and received intrathecal chemotherapy. The cerebrospinal fluid showed no residual disease. After stabilization, his father's lymphocytes were collected for CAR-T cell culture. On 19 November, donor CD7 CAR-T cells were infused into the patient.

Days after the infusion, before CAR-T cell expansion, tumor cells rapidly proliferated again, with abundant blasts observed in peripheral blood, marking the failure of the first CAR-T therapy.

At this time, Tianjin Cancer Hospital Airport Hospital was conducting a clinical trial of universal CAR-T (CD7 UCAR-T) for acute T-lymphoblastic leukaemia. The parents expressed desperate urgency, stating they would pursue even a 1% chance for their child. The medical team discussed with the family and decided to enroll the patient in the CD7 UCAR-T clinical trial.

Complete remission after CD7 UCAR-T Now 2 months post-transplant.

On 2 December, the patient received CD7 U-CART cell infusion alongside tumor load-reduction therapy and supportive care. Post-infusion, he experienced prolonged high fever and lethargy. With anti-infective and hydration support, his vital signs stabilized and body temperature normalized.

Bone marrow and cerebrospinal fluid assessments on days 18 and 28 post-CAR-T confirmed complete remission with MRD negativity. The child’s condition improved markedly his energy returned, appetite recovered, and his mother—previously distraught—regained hope.

Currently, the patient has undergone a second haploidentical HSCT at Tianjin Cancer Hospital Airport Hospital and remains in complete remission 2 months post-transplant.