Discussing the Role of CAR T-Cell Therapy for Patients with ALL

Hagop M. Kantarjian, MD, professor and chair of the Department of Leukemia at The University of Texas MD Anderson Cancer Center, and the Samsung Distinguished Leukemia Chair in Cancer Medicine, discusses the introduction of chimeric antigen receptor (CAR) T cells and their impact on acute lymphoblastic leukemia (ALL).

The ALL space has recently been moving away from chemotherapy and transplantation and more toward therapies to improve survival rates and reach more likely rates of remission.

CAR T cells are currently approved by the FDA for patients with relapsed/refractory ALL. While first-generation CAR T cells have even demonstrated a 2-year survival rate of around 50% in children, few adult patients with ALL achieved remission with the use of CAR T cells in active disease. These patients benefit from second-generation CAR T cells as they have produced 2-year survivals of 20% to 40%.

Data have also demonstrated that CAR T cells work better when infused in the setting of minimal residual disease (MRD) and inactive disease. Kantarjian notes the future of this space may consist of using CAR T cells post chemoimmunotherapy, and infusing CAR T cells in the patients who have complete remission of MRD.

Transcription:

0:08 | CAR T cells are very important, and maybe again are a cytopathic revolution in myeloma and lymphoma. In ALL, the first-generation CAR T cells have been able to produce a 2-year survival rate of maybe 50% in children. But in adults with ALL, when we use CAR T cells in active disease, very few patients are cured. The second-generation CAR T cells are better, and they produced 2-year survivals of about 20% to 40% in adults and older patients. But there is data now that shows that they work better if they are infused in the setting of MRD and inactive disease.

0:57 | Even though the FDA approval for CAR T cells is for relapsed/refractory ALL, I think their best use and the best results will be if they are infused in the setting of MRD or inactive disease. Patients are covered for treatment with the CAR T cells for active disease but then they receive preparative regimens like fludarabine, cyclophosphamide and if they happen to get into a MRD status or even MRD negativity, then their 2-year survival goes to above 70%. In the future, we have to think maybe using the CAR T cells after giving the patients some form of chemoimmunotherapy like chemotherapy with blinatumomab and inotuzumab and then infuse the CAR T cells in the setting of MRD in complete remission.