Definitely CAR T-cells are the major breakthrough over the last few years in the field of haematology and today we are fortunate enough to have two commercially available products approved and being increasingly used for the treatment of ALL and non-Hodgkin lymphoma. What we have seen these days is that definitely we have mature results and a substantial proportion of ALL in non-Hodgkin lymphoma patients are definitely cured after these CAR T-cells. So this is wonderful news for the patient.
Initially there were some, I would say, concerns about the serious side effects of these CAR T-cells, namely the cytokine release syndrome and neurotoxicity. This is, of course, an important issue and we need to tackle it. However, we have seen awareness being increased and the management of these complications is being improved. Now people after having the proof of concept, after having hundreds of patients treated, actually the community is already moving to the next step – targeting other antigens, having dual CAR T-cells, for example in lymphoma CD19 and CD22. But also the major issue we are facing is the lack of persistence of these cells. So this is why a lot of work is still to be done and there are many different avenues to try to improve or to allow or to increase the expansion of these cells in vivo – use of cytokines, armoured CAR T-cells, the checkpoint inhibitors in combination with CAR T-cells can be of interest. We’ve seen some results in CLL where ibrutinib, for example, can help or can favour the persistence of these cells. So this is really an exciting era for investigation but definitely CAR T-cells are becoming a key component of the management of ALL and non-Hodgkin lymphoma.