{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T08:18:22Z","timestamp":1788164302369,"version":"build-2803163510"},"reference-count":60,"publisher":"Springer Science and Business Media LLC","license":[{"start":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T00:00:00Z","timestamp":1788134400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T00:00:00Z","timestamp":1788134400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Leukemia"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>\n                    This multicenter real-world study identifies critical determinants of outcome for tisagenlecleucel (tisa-cel) in treating post-HSCT relapse in 220 children\/young adults with B-ALL from 31 European centers. Median follow-up was 30.0 months, with a 43.6% 2-year event-free survival (EFS), 67.2% overall-survival (OS), and 57.1% incidence of CAR-T failure. CAR-T for relapse after transplant from a matched sibling donor (MSD) compared to alternative donors was associated with lower 2-year-OS (MSD 59.1%, mismatched donor MMD 80.2%, matched family\/unrelated donor MFD\/MUD 68.3%,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.046). Two-year incidence of CAR-T failure was highest for MSD (MSD 73.8%, MFD\/MUD 49.7%, MMD 52.2%,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.006). Patients who had relapsed early (&lt;\u00a06 months post HSCT) showed inferior 2-year-EFS (23.7%) and OS (47.2%) compared to patients with late relapse, \u2265\u00a06 months after HSCT (EFS 49.8%,\n                    <jats:italic>p\u2009<\/jats:italic>\n                    =\u20090.001; OS 73.9%,\n                    <jats:italic>p\u00a0<\/jats:italic>\n                    &lt;\u00a00.001). Early relapse was associated with a higher incidence of CAR-T failure and relapse after tisa-cel, particularly CD19+ relapses. Outcomes correlated with disease burden at lymphodepletion: 2-year-OS was 81.7% for MRD\u2013, 69.2% for MRD+, and 55.2% for patients in non-remission (\n                    <jats:italic>p\u2009<\/jats:italic>\n                    =\u20090.003), with incidence of CAR-T failure highest in non-remission. Prior transplant from an MSD, early post-HSCT relapse, and disease burden at lymphodepletion identify patients at increased risk of CAR-T failure after HSCT.\n                  <\/jats:p>","DOI":"10.1038\/s41375-026-03105-y","type":"journal-article","created":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T07:07:49Z","timestamp":1788160069000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Tisagenlecleucel for post-transplant relapse in young acute lymphoblastic leukemia patients: European real-world determinants of outcome"],"prefix":"10.1038","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1241-5137","authenticated-orcid":false,"given":"Laura 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FAA: Honoraria: AbbVie, BMS, Kite\/Gilead, Janssen, Therakos, Miltenyi Biomedicine, Novartis, Takeda, Medac, Neovii; Research Support: Therakos, Neovii. PB: Advisory Board: Novartis, Cellgene, Amgen; Speaker\u2019s Bureau: Miltenyi, Jazz, Riemser, Novartis, and Amgen; Licensing Fees and Royalties: medac; Institutional: Research Support Neovii, Riemser, medac, and Amgen. CB: Amgen, Gilead, Janssen, Novartis, Jazz, BMS, Pfizer. AB: Speaker\u2019s Bureau: Novartis; Advisory Board: Novartis, Sanofi, and Jazz; DSMC for Orchards. ABar: AstraZeneca, Jazz, Servier, Sanofi, Amgen; Research Support: Servier. HB: Speaker\u2019s Bureau: Medac, Miltenyi, Novartis, and Terumo BCT; Research Support: Erydel, Miltenyi, Sandoz-Hexal, Terumo BCT; Consultation\/Advisory Board: Boehringer-Ingelheim Medvet, Byondis, Celgene, Medac, Novartis, Sandoz-Hexal; Royalties: Medac; Stock Ownership: Healthineers. JB: Advisory Board: Medac, Novartis, Pfizer, Amgen; Speaker\u2019s Bureau: Novartis; DMC: Novartis. NB: Amgen, Incyte, Jazz Pharma, Novartis, Pfizer, and Servier; Research Support: Amgen, Novartis, Incyte, Jazz Pharma, and Sanofi. VB: Amgen, Gilead, Novartis, Pfizer; Advisory Board: Priothera; Research Support: Gilead\/Kite and Miltenyi Biotec; Educational Grants: BMS, Novartis, Takeda, and Roche; Speaker\u2019s Bureau: Novartis, Pfizer. GC: Amgen; Speaker\u2019s Bureau: Servier; Advisory Board: JazzPharma; Travel Support: JazzPharma. BDM: Travel Grants: Astra Zeneca, Amgen, and Jazz Pharma; Institutional: Research Support: Novartis, Amgen, and Pfizer. SG: Honoraria from Novartis, Trial Steering Committee for Autolus; Institutional: UCLB: patents, royalties. MH: Travel Support: Neovii. AJ: Advisory Board and Speaker\u2019s Bureau: Novartis, Pfizer, Vertex, and Medac. KK: Speaker\u2019s Bureau: Novartis. JHK: Advisory Board: Jazz, Boehringer, and Pfizer. FL: Advisory Board and Speaker\u2019s Bureau Novartis, AMGEN, Vertex, Gliead, Medac, Neovii, Sanofi, Miltenyi. RM: Advisory Board: Novartis, Medac, Celgene\/BMS, Bluebird Bio, Crispr Therapeutics, and Vertex; Speaker\u2019s Bureau: Crispr Therapeutics and Vertex; Research Support: Jazz, Miltenyi Biotech, Neovii, Novartis, Celgene\/BMS, Gilead\/KITE, Crispr Therapeutics, and Vertex. PM: Consulting Fee from SOBI, Miltenyi, Amgen, and Pierre Fabre. FM: Advisor to Abbvie, ArgoBio, AstraZeneca, BeOne, BMS, Cabaletta, CRISPR Therapeutics, Incyte, Janssen, Kite\/Gilead, Lilly, Miltenyi, Novartis, Regeneron, and Sobi; Honoraria from Abbvie, AstraZeneca, BeiOne, BMS, Incyte, Janssen, Kite\/Gilead, Miltenyi, MSD, Novartis, Pfizer, Sobi, and Takeda, Research Support from AstraZeneca, BMS, Kite\/Gilead, and Miltenyi. IM: Speaker\u2019s Bureau: Novartis. OP: Advisory Board: Gilead, Jazz, MSD, Neovii, Novartis, Pfizer, and Therakos; Equillium Bio, Jazz, Gilead, Novartis, MSD, Omeros, Priothera, Sanofi, Shionogi, SOBI; Research Grants: Incyte, Priothera. FR: Kite\/Gilead, Jazz Pharmaceuticals. SR: Advisory Board: Novartis, Pfizer, OneChain Immunotherapeutics, and Amgen; Speaker\u2019s Bureau: Amgen; DMC: Amgen, Autolus. CR: Advisory Board: Amgen and Novartis. AvS: Advisory Board: Amgen and Novartis; Speaker\u2019s Bureau: Amgen and Novartis. All other authors have nothing to declare.","order":1,"name":"Ethics","label":"Competing interests","group":{"name":"EthicsHeading","label":"Ethics"}},{"value":"This study was performed in accordance with the Declaration of Helsinki and all relevant guidelines and regulations. The study was approved by the Ethics Committee of the University of Frankfurt am Main, Germany (approval number: 2021-376). Patients or their legal guardians provided written informed consent or assent for the reporting of pseudonymized data to this registry in accordance with European data protection regulations. 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