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We performed a multicenter retrospective study to assess whether patients can benefit from haploidentical hematopoietic stem cell transplantation after CAR-T therapy.<\/jats:p>\n<\/jats:sec><jats:sec>\n<jats:title>Methods<\/jats:title>\n<jats:p>A total of 122 patients after CAR-T therapy were enrolled, including 67 patients without subsequent transplantation (non-transplant group) and 55 patients with subsequent haploidentical hematopoietic stem cell transplantation (transplant group). Long-term outcome was assessed, as was its association with baseline patient characteristics.<\/jats:p>\n<\/jats:sec><jats:sec>\n<jats:title>Results<\/jats:title>\n<jats:p>Compared with the non-transplant group, transplantation recipients had a higher 2-year overall survival (OS; 77.0% versus 36.4%; <jats:italic>P<\/jats:italic> &lt; 0.001) and leukemia-free survival (LFS; 65.6% versus 32.8%; <jats:italic>P<\/jats:italic> &lt; 0.001). Multivariate analysis showed that minimal residual disease (MRD) positivity at transplantation is an independent factor associated with poor LFS (<jats:italic>P<\/jats:italic> = 0.005), OS (<jats:italic>P<\/jats:italic> = 0.035), and high cumulative incidence rate of relapse (<jats:italic>P<\/jats:italic> = 0.045). Pre-transplant MRD-negative recipients (MRD\u2212 group) had a lower cumulative incidence of relapse (17.3%) than those in the non-transplant group (67.2%; <jats:italic>P<\/jats:italic> &lt; 0.001) and pre-transplant MRD-positive recipients (MRD+ group) (65.8%; <jats:italic>P<\/jats:italic> = 0.006). The cumulative incidence of relapse in MRD+ and non-transplant groups did not differ significantly (<jats:italic>P<\/jats:italic> = 0.139). The 2-year LFS in the non-transplant, MRD+, and MRD\u2212 groups was 32.8%, 27.6%, and 76.1%, respectively. The MRD\u2212 group had a higher LFS than the non-transplantation group (<jats:italic>P<\/jats:italic> &lt; 0.001) and MRD+ group (<jats:italic>P<\/jats:italic> = 0.007), whereas the LFS in the MRD+ and non-transplant groups did not differ significantly (<jats:italic>P<\/jats:italic> = 0.305). The 2-year OS of the MRD\u2212 group was higher than that of the non-transplant group (83.3% versus 36.4%; <jats:italic>P<\/jats:italic> &lt; 0.001) but did not differ from that of the MRD+ group (83.3% versus 62.7%; <jats:italic>P<\/jats:italic> = 0.069). The OS in the non-transplant and MRD+ groups did not differ significantly (<jats:italic>P<\/jats:italic> = 0.231).<\/jats:p>\n<\/jats:sec><jats:sec>\n<jats:title>Conclusion<\/jats:title>\n<jats:p>Haploidentical hematopoietic stem cell transplantation with pre-transplant MRD negativity after CAR-T therapy could greatly improve LFS and OS in patients with relapsed\/refractory acute lymphoblastic leukemia.<\/jats:p>\n<\/jats:sec><jats:sec>\n<jats:title>Trial registration<\/jats:title>\n<jats:p>The study was registered in the Chinese clinical trial registry (<jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"http:\/\/www.chictr.org.cn\/showproj.aspx?proj=39004\">ChiCTR1900023957<\/jats:ext-link>).<\/jats:p>\n<\/jats:sec>","DOI":"10.1186\/s13045-020-00873-7","type":"journal-article","created":{"date-parts":[[2020,5,4]],"date-time":"2020-05-04T12:03:50Z","timestamp":1588593830000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":81,"title":["Pre-transplant MRD negativity predicts favorable outcomes of CAR-T therapy followed by haploidentical HSCT for relapsed\/refractory acute lymphoblastic leukemia: a multi-center retrospective 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