Outcomes of Chimeric Antigen Receptor T-cell (CAR-T) Cell Therapy in Hematological Malignancies - A Systematic Review and Meta Analysis

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INTRODUCTION: CAR T therapy is used in various hematological malignancies that involve genetic modification of autologous T cells to target tumor cells. The aim of this meta-analysis was to evaluate the efficacy and safety of CAR T cell therapy in haematological malignancies with relation to response rates, survival outcomes, and treatment-related adverse events. METHODS: This meta-analysis followed PRISMA guidelines. 428 records were identified from Pub- Med, Embase, Web of Science, Scopus, Cochrane Library, and Google Scholar for studies between 2019 and 2024. Clinical trials and observational studies evaluating CAR T therapy in haematological malignancies were included. Study quality was assessed using the Newcastle Ottawa Scale and ROBINS I tool. Random effects models were used, and heterogeneity was measured with the I² statistic. RESULTS: Twelve studies met the inclusion criteria. CAR T therapy showed high ORR and CR in Bcell malignancies, with ORR reaching 90.5% in R/R B NHL and 81% remission in B ALL. CRS was common but mainly mild to moderate, while neurotoxicity and GvHD were less frequent. Metaanalysis demonstrated substantial heterogeneity for ORR, CR, and CRS. Most studies were rated good quality, though moderate bias related to missing data and design differences was observed. DISCUSSION: Meta-analysis shows CAR T therapy achieves high ORR and durable remission in B ALL and DLBCL. CD19-directed therapy was promising. Compared to myeloid cell malignancies, B-cell malignancies showed better response. These findings point towards optimisation of protocol and appropriate patient selection apart from the toxicity management, which is required to improve the outcomes. CONCLUSION: CAR T therapy shows high response rates in haematological malignancies with controllable toxicity, thus establishing its role in relapsed and refractory disease. It highlights the need for improved durability, access, and constant clinical application.

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