Autologous Anti-CD19 CAR T-Cells immunotherapy in relapsed/refractory acute lymphoblastic leukemia patients. A systematic review and meta-analysis/Imunoterapia de CAR T-Cells Anti-CD19 no tratamento de leucemia linfoblastica aguda refrataria/recidivante. Revisao sistematica e metanalise

Introduction: Acute Lymphoblastic Leukemia (ALL) is the most prevalent malignancy in children; however, when the neoplasm becomes refractory/relapses (R/R) the cure possibilities are practically null. Objectives: To analyze the Anti-CD19 Chimeric Antigen Receptors (CAR) T-Cells immunotherapy efficacy in the treatment of R/R ALL, providing evidence about the efficacy and safety of the therapy for the analyzed group. Methods: The study consisted of a systematic review and meta-analysis based on the analysis of indexed articles. The searches were carried out with the terms: "acute lymphoblastic leukemia", "CAR T", and "CD19-specific chimeric antigen receptor". Results: Only 18 of the 94 articles obtained initially met the inclusion criteria and were selected for review, totaling 637 patients. Thus, it was observed in the responses that approximately 81% of the patients achieved a Complete Response; 7% did not respond; the neoplasm relapsed in 17% of the cases; and 6.1% of the patients died. The main side effects found were Cytokine Release Syndrome (CRS), Severe Cytokine Release Syndrome, and Neurotoxicity, present in 36.3%, 29%, and 24% of patients, respectively. Conclusion: Anti-CD19 CAR T-Cells immunotherapy is an effective therapy, capable of producing high rates of complete remission in R/R ALL treatment. Keywords: Immunotherapy; Chimeric antigen receptors; CD19 antigens; B-cell leukemia. Introducao: A Leucemia Linfoblastica Aguda (LLA) e a neoplasia maligna mais prevalente em criancas; entretanto, quando se torna refrataria/recidivante (R/R) as possibilidades de cura sao praticamente nulas. Objetivos: Analisar a eficacia da imunoterapia de Receptores de Antigenos Quimericos anti-CD19 no tratamento da LLA R/R, fornecendo evidencias sobre a efetividade e seguranca da terapia para o grupo analisado. Metodos: O estudo consistiu em uma revisao sistematica e metanalise baseada em artigos indexados. As pesquisas foram realizadas com os termos: "acute lymphoblastic leukemia", "CAR T", and "CD19-specific chimeric antigen receptor". Resultados: Dos 94 artigos obtidos, apenas 18 atenderam inicialmente aos criterios de inclusao e foram selecionados para revisao, totalizando 637 pacientes. Assim, observou-se nas respostas que aproximadamente 81% dos pacientes obtiveram resposta completa; 7% nao responderam; a neoplasia recidivou em 17% dos casos; e 6,1% dos pacientes morreram. Os principais efeitos colaterais encontrados foram sindrome de liberacao de citocinas, sin