CART-T cell therapy in young patients with relapsed/refractory ALL

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Published: 23 Jan 2020
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Prof Peter Bader - Universitätsklinikum Frankfurt, Frankfurt, Germany

Prof Peter Bader speaks to ecancer at the 2020 ALL Assembly meeting in Frankfurt about the use of blinatumomab and HSCT versus CART-T cell therapy for the treatment of young patients with relapsed/refractory acute lymphoblastic leukaemia (ALL).

He emphasises the importance of this debate, in which there is more follow-up evidence available supporting the effectiveness of blinatumomab in this patient population.

Prof Bader outlines some of the disadvantages and advantages of CART-T cell therapy, where the associated long-term toxicities are considered to be less compared to stem cell transplantation.

 

I’m really looking forward to this debate together with Franco Locatelli because we are discussing really burning questions, such as how to use novel and specific treatment options for the cure of children with acute lymphoblastic leukaemia. This is blinatumomab, this is CAR T-cells and it’s really important. There is no final position on what is the best therapy and we have to find out for which patients we have to use it.

What will you be trying to put forward in the debate?

My position is to promote CAR T-cells and show the options and the possibilities using CAR T-cells to treat patients, high risk patients, children and young adults with ALL. However, my position is both the treatment options are really valuable and important to be used. Finally it’s blinatumomab, for example, which has proven to be extremely effective in relapsed patients, preparing them for allogeneic stem cell transplantation and improve the survival rate. CAR T-cells, yes, in principle they can do this as well but the follow-up and the clinical experience is by far less than with blinatumomab so far. But we can clearly imagine that there might be patients who will benefit from CAR T-cells more than from blinatumomab, for example.

What can be the disadvantages of CAR T-cell therapy?

The disadvantage is difficult to mention because now we are doing transplants for, let’s say, forty years. There are really several, ten thousands of children being treated by stem cell transplantation and we can clearly identify risk factors and we know how to use this type of treatment to cure. For a long time patients with high risk profiles of lymphoblastic leukaemia and CAR T-cells, it’s only available since a very few years and there are not even a thousand children being treated with the CAR T-cells. So we have been very careful to give opinion about the long-term effect of the treatment. but here clearly advantages of this type of treatment could be that the long-term toxicity probably is to be considered less than with stem cell transplantation.

What do you feel will be the key take-home message from the debate?

I’m hoping that we will be able to identify patients who might really benefit from blinatumomab in combination with allogeneic transplantation. Hopefully we will be able to rule out which patients are the ones who most likely benefit from CAR T-cell treatment and there I do have ideas and we will discuss this tomorrow.