The what, when and how of CAR T cell therapy for ALL

• Published in: Best practice & research. Clinical haematology Vol. 30; no. 3; pp. 275 - 281
• Main Author: Frey, Noelle
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Ltd 01.09.2017
• Subjects: Acute lymphoblastic leukemia; Antigens, CD19 - genetics; Antigens, CD19 - immunology; Chimeric antigen receptor T cells; Clinical Trials as Topic; Cytokine release syndrome; Gene Expression; Hematopoietic Stem Cell Transplantation; Humans; Immunotherapy, Adoptive - methods; Precision Medicine; Precursor Cell Lymphoblastic Leukemia-Lymphoma - immunology; Precursor Cell Lymphoblastic Leukemia-Lymphoma - mortality; Precursor Cell Lymphoblastic Leukemia-Lymphoma - pathology; Precursor Cell Lymphoblastic Leukemia-Lymphoma - therapy; Receptors, Antigen, T-Cell - genetics; Receptors, Antigen, T-Cell - immunology; Recombinant Fusion Proteins - genetics; Recombinant Fusion Proteins - immunology; Remission Induction; Survival Analysis; T-Lymphocytes - cytology; T-Lymphocytes - immunology; T-Lymphocytes - transplantation; Transplantation, Homologous; Acute lymphoblastic leukemia; Chimeric antigen receptor T cells; Cytokine release syndrome
• ISSN: 1521-6926; 1532-1924; 1532-1924
• DOI: 10.1016/j.beha.2017.07.009

Chimeric Antigen Receptor (CAR) T cells that have been engineered to target CD19 have shown great promise in patients with relapsed and refractory B cell acute lymphocytic leukemia with remission rates of 70–90%. Some remissions have successfully bridged patients to a curable allogeneic stem cell transplant, some responses have been durable without further treatment, and some patients have achieved durable remissions for relapsed ALL after allogeneic stem cell transplant. Cytokine release syndrome, correlating with the in vivo activation and expansion of T cells, and neurologic toxicity are the most significant side effects and approaches to better understand and manage these events are the subject of ongoing clinical trials. The decision to intervene with CARTs requires an individualized approach taking into consideration patient, disease and therapy related factors.