Abstract
Introduction: Treatment of relapsed and refractory (R/R) B acute lymphoblastic leukemia (B-ALL) represents an unmet medical need in children and adults. Adoptive T cells engineered to express a chimeric antigen receptor (CAR-T) is emerging as an effective technique for treating these patients. Areas covered: Efficacy and safety of CAR-T therapy in R/R B-ALL patients. Expert opinion: CD19 CAR-T infusion induce high CR rates in patients with poor prognosis and few therapeutic options, while real-life data demonstrate similar results with an interestingly lower incidence of grade 3/4 toxicity. Nevertheless, despite impressive in-depth responses, more than half of patients will experience a relapse. Therefore, rather than using CAR-T cell therapy as a stand-alone option, consolidation with allogeneic stem-cell transplant (Allo-SCT) after CAR-T treatment might increase long-term outcome. Moreover, CD19 is one target, but several other targets are being examined, such as CD20 and CD22 and dual-targeting CARs or combination therapy. Another issue is the time consuming process of CAR-T engineering. New platforms have shortened the CAR-T cell manufacturing process, and studies are underway to evaluate the effectiveness. Another way to mitigate waiting is the development of allogeneic “off the shelf” therapy. In conclusion, CD19-targeted CAR-modified T-cell therapy has shown unprecedented results in patients without curative options. Future work focusing on target identification, toxicity management and reducing manufacturing time will broaden the clinical applicability and bring this exciting therapy to more patients, with longer-term remissions without additional Allo-SCT.
Highlights
Treatment of relapsed and refractory (R/R) B acute lymphoblastic leukemia (B-ALL) represents an unmet medical need in children and adults
The authors showed that treatment with a relatively low dosage of T-cells transduced with this CAR vector induced complete remission (CR) in 80% (24/30) patients that could be evaluated on day 30 (76% attained minimal residual disease (MRD)-), and in 70.5% (24/34) of all enrolled patients
Yang et al reported at the 2020 American Society of Hematology (ASH) Annual Meeting data on an anti-CD19/CD22 dual chimeric antigen receptor (CAR-T) (GC022F) therapy in patients with B-ALL based on a novel manufacturing platform, from a phase I clinical study in treating patients with B-ALL [59]
Summary
Massimo Martino 1, *, Caterina Alati 2 , Filippo Antonio Canale 1 , Gerardo Musuraca 3 , Giovanni Martinelli 3 and Claudio Cerchione 3, *. Stem Cell Transplant and Cellular Therapies Unit, Hemato-Oncology and Radiotherapy Department,
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