Dr. Brentjens on Treatment With CAR-Modified T Cells
Renier J. Brentjens, MD, PhD, Leukemia Service, Memorial Sloan-Kettering Cancer Center, discusses the treatment of B-cell malignancies with chimeric antigen receptor(CAR)–modified T cells.
This method of treatment goes back almost 10 years, Brentjens says, and started in low-grade B-cell malignancies. As researchers became more comfortable with the technology, they began treating adult B-cell acute lymphoblastic leukemia (ALL), a disease with far worse prognosis. Patients with this disease have a poor prognosis from the time of diagnosis, Brentjens says, and have an even worse prognosis if the disease comes back after initial treatment. The only option for patients who have relapsed is through a salvage chemotherapy regimen, which hopefully gets them back into remission. These patients then undergo an allogeneic bone marrow transplant and hope that the disease does not return. Unfortunately, many patients who relapse never get back into remission, eliminating the option of a transplant.
This is a desperate population that deserves attention, Brentjens says. In a clinical trial, all patients tolerated treatment with CAR–modified T cells and, more significantly, went into a minimal residual disease negative complete remission. Even with highly sensitive detection methods, B cell ALL tumor cells could not be detected. This demonstrated that these patients are optimally primed for subsequent bone marrow transplantation and had the greatest chance of long-term survival.