Analysis of the therapeutic effect of allogeneic hematopoietic stem cell transplantation in the treatment of pediatric acute lymphoblastic leukemia with E2A::HLF fusion gene - a case series

Q: What is the E2A::HLF fusion gene and why is it important in pediatric ALL?

E2A::HLF (TCF3::HLF) is a fusion gene present in less than 1% of B-cell ALL patients, mainly older children and adolescents. Patients with this fusion consistently show poor outcomes even after HSCT.

Q: How were CAR-T and DLI used in the reported treatment approach?

The series emphasizes giving CAR-T therapy before HSCT and using prophylactic DLI after HSCT. Two patients received CD19-CAR-T after non-remission to intensive therapy, and DLI was given after HSCT for patients who fit that sequence.

Q: What outcomes did the case series report after HSCT and cellular therapies?

All four patients achieved complete remission before HSCT with negative minimal residual disease and E2A::HLF fusion in bone marrow. One patient died from HSCT complications, one relapsed after HSCT, and two patients remained alive after post-HSCT DLI.

Sep 29, 2026

Uploaded by Rizky

Retrospective case-series analysis evaluates the therapeutic impact of allogeneic hematopoietic stem cell transplantation (allo-HSCT) in four pediatric patients with E2A::HLF (TCF3::HLF) fusion–positive B-cell acute lymphoblastic leukemia (B-ALL). The study focuses on safety and effectiveness when CAR-T therapy is delivered before HSCT and donor lymphocyte infusion (DLI) is used afterward. All patients achieved complete remission before HSCT and were negative for minimal residual disease and the E2A::HLF fusion in bone marrow. One patient died from HSCT complications, one relapsed post-HSCT, while two remained alive after post-HSCT DLI.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages8

Reading Time20 min

AccessFree to download

Introduction

Background on E2A::HLF fusion and treatment context

Case Description

Patient cohort and treatment sequence

Conclusions

CAR-T before HSCT and DLI after HSCT strategy

Highlight Box

Key findings and clinical implications

Analysis of the therapeutic effect of allogeneic hematopoietic stem cell transplantation in the treatment of pediatric acute lymphoblastic leukemia with E2A::HLF fusion gene: a case series Yuanfang Jing\#, Ang Wei\#, Chenguang Jia, Jun Yang, Guanghua Zhu, Yanhui Luo, Kaige Zhang, Wei Yang, Wei Chen, Meng Zhang, Maoquan Qin, Bin Wang Beijing Key Laboratory of Pediatric Hematology Oncology, National Key Discipline of Pediatrics (Capital Medical University), Key Laboratory of Major Diseases in Children, Ministry of Education, Department of Stem cell Transplantation, Beijing Children’s Hospital, Capital Medical University; National Center for Children’s Health, Beijing, China Contributions: (I) Conception and design: Y Jing, A Wei; (II) Administrative support: C Jia, J Yang, B Wang; (III) Provision of study materials or patients: G Zhu, Y Luo, K Zhang; (IV) Collection and assembly of data: W Yang, W Chen, A Wei; (V) Data analysis and interpretation: Y Jing, M Zhang, A Wei, M Qin; (VI) Manuscript writing: All authors; (VII) Final approval of manuscript: All authors. \#These authors contributed equally to this work as co-first authors. Correspondence to: Maoquan Qin, MD; Bin Wang, MD. Beijing Key Laboratory of Pediatric Hematology Oncology, National Key Discipline of Pediatrics (Capital Medical University), Key Laboratory of Major Diseases in Children, Ministry of Education, Department of Stem cell Transplantation, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, No. 56 Nanlishi Road, Xicheng District, Beijing 100045, China. Email: [qinmq3966@qq.com](qinmq3966@qq.com); [wbin@medmail.com.cn](wbin@medmail.com.cn). Background: The fusion gene E2A::HLF (TCF3::HLF) is present in <1% of B-cell acute lymphoblastic leukemia (ALL) patients, mainly in older children and adolescents. Patients with E2A::HLF fusion B-ALL consistently have dismal outcomes, even after hematopoietic stem cell transplantation (HSCT) . Chimeric antigen receptor T-cell (CAR-T) therapy and donor lymphocyte infusion (DLI) applied in this kind of disease have rarely been reported. In this case series, we will focus on the safety and effectiveness of CAR-T and DLI treatments. This may refine therapeutic strategies and improve survival for this high-risk subgroup. Case Description: In this case series, we review the clinical course of 4 pediatric patients with E2A::HLF fusion B-ALL. All four patients treated with Chinese Children Leukemia Group (CCLG)-2018-ALL protocol based on high-risk stratification. Two patients (case 1 and case 4) maintained non-remission after intensive therapy and then accepted CD19-CAR-T therapy. All four patients achieved complete remission before HSCT and were negative for minimal residual disease and E2A::HLF fusion in the bone marrow. One patient (case 3) succumbed to complication of HSCT. Two patients (case 1 and case 4) who accepted DLI treatment after HSCT were still alive. One patient (case 2) relapsed after HSCT. Although accepting CAR-T and DLI treatments after HSCT, she died due to primary disease recurrent relapse. Conclusions: The combination of CAR-T-cell therapy before HSCT and pro-DLI treatment after HSCT may represent an effective strategy to improve outcomes in these pediatric patients. Keywords: Acute lymphoblastic leukemia (ALL); E2A::HLF; hematopoietic stem cell transplantation (HSCT); pediatric; case series Submitted Sep 11, 2025. Accepted for publication Oct 30, 2025. Published online Dec 15, 2025. doi: 10.21037/tp-2025-631 View this article at: [https://dx.doi.org/10.21037/tp-2025-631](https://dx.doi.org/10.21037/tp-2025-631) © AME Publishing Company. Transl Pediatr 2025;14(12):3441-3448 | [https://dx.doi.org/10.21037/tp-2025-631](https://dx.doi.org/10.21037/tp-2025-631) 3442 Jing et al. HSCT for ALL with E2A::HLF Introduction Acute lymphoblastic leukemia (ALL) is a malignancy that affects white blood cells (i.e., B and T lymphocytes), r

FAQs

What is the E2A::HLF fusion gene and why is it important in pediatric ALL?

E2A::HLF (TCF3::HLF) is a fusion gene present in less than 1% of B-cell ALL patients, mainly older children and adolescents. Patients with this fusion consistently show poor outcomes even after HSCT.

How were CAR-T and DLI used in the reported treatment approach?

The series emphasizes giving CAR-T therapy before HSCT and using prophylactic DLI after HSCT. Two patients received CD19-CAR-T after non-remission to intensive therapy, and DLI was given after HSCT for patients who fit that sequence.

What outcomes did the case series report after HSCT and cellular therapies?

All four patients achieved complete remission before HSCT with negative minimal residual disease and E2A::HLF fusion in bone marrow. One patient died from HSCT complications, one relapsed after HSCT, and two patients remained alive after post-HSCT DLI.

Sep 29, 2026

Uploaded by Rizky