biostudies-literatureMikami TKyoto UniversityThe Kyoto University FoundationPrincess Takamatsu Cancer Research FundFriends of Leukemia Research FundTakeda Science FoundationJapan Agency for Medical Research and DevelopmentThe Mother and Child Health FoundationChild Health FoundationJapan Society for the Promotion of Science102576https://www.ebi.ac.uk/biostudies/studies/S-EPMC12923955biostudies-literatureUnknown7(2)Anti-CD19 chimeric antigen receptor T cell (CAR-T) therapy is highly effective for B cell precursor acute lymphoblastic leukemia (BCP-ALL); however, approximately half of the patients relapse. Thus, there is an urgent need to identify factors that improve efficacy. This study enrolls 19 patients with BCP-ALL (16 children and 3 young adults) who receive tisagenlecleucel. Infusion products, peripheral blood, and bone marrow samples are obtained before and after CAR-T cell infusion. Single-cell analysis reveals that central memory CAR^pos T cells increase in long-term responders, whereas CXCR3⁺CD38^highPD-1^high effector CAR^pos T cells are enriched in relapsed patients, post-infusion. By contrast, CAR^pos T cells obtained from infuCell reports. MedicineCAR-T cells with the CD38<sup>-</sup>CD73<sup>-</sup>Tim-3<sup>-</sup>HLA-DR<sup>+</sup> phenotype predict the efficacy of tisagenlecleucel as a treatment for B cell precursor ALL.PMC1292395523ama221505h000224ama221531h000125ama221531h0002JP21ck0106531JP24H00628JP21K1940523ama221514h002JP23K18264JP20H0052822ama221514h0001JP22K07211Llamas-Covarrubias MAUmeda KWing JBSaida SMikami TTakita JKato IKitawaki TMitsuyoshi TUchihara YTakaori-Kondo AHiramatsu HOgawa SfalseCAR-T cells with the CD38<sup>-</sup>CD73<sup>-</sup>Tim-3<sup>-</sup>HLA-DR<sup>+</sup> phenotype predict the efficacy of tisagenlecleucel as a treatment for B cell precursor ALL.Anti-CD19 chimeric antigen receptor T cell (CAR-T) therapy is highly effective for B cell precursor acute lymphoblastic leukemia (BCP-ALL); however, approximately half of the patients relapse. Thus, there is an urgent need to identify factors that improve efficacy. This study enrolls 19 patients with BCP-ALL (16 children and 3 young adults) who receive tisagenlecleucel. Infusion products, peripheral blood, and bone marrow samples are obtained before and after CAR-T cell infusion. Single-cell analysis reveals that central memory CAR^pos T cells increase in long-term responders, whereas CXCR3⁺CD38^highPD-1^high effector CAR^pos T cells are enriched in relapsed patients, post-infusion. By contrast, CAR^pos T cells obtained from infu2026-01-01T00:00:00Z2026 Feb2026-07-16T15:13:27.932Z2026-07-10T03:09:18.564ZS-EPMC129239554157986010.1016/j.xcrm.2025.102576