Katherine (Katie) Tobon, PharmD

Experts share their final thoughts on the unmet needs and future perspectives of chimeric antigen receptor (CAR) T-cell therapy for hematologic malignancies, emphasizing areas for improvement and potential advancements in treatment.

Experts discuss the key characteristics of the patient, disease, and CAR T-cell construct considered when determining if a patient with minimal residual disease (MRD)–negative complete response (CR) post chimeric antigen receptor (CAR) T-cell therapy should proceed to consolidative stem cell transplant (SCT), the circumstances under which CAR T-cell therapy could be considered a standalone treatment, principal risk factors for relapsed disease and strategies for prevention or mitigation, the impact of early T-cell exhaustion on the decision to proceed with allogeneic hematopoietic SCT (allo-HSCT) in previous CAR T-cell recipients, and other factors that influence that decision.

Experts discuss their combined experience with cytokine release syndrome (CRS), immune effector cell–associated neurotoxicity syndrome (ICANS), and other immunotoxicities post chimeric antigen receptor (CAR) T-cell therapy, whether Moffitt Cancer Center implements a standardized protocol to address and resolve cell therapy–associated immunotoxicities, how interventions are modified across grades of severity, and the use of prophylactic strategies to mitigate treatment-related adverse events as well as the roles of the multidisciplinary team in patient monitoring during the initial 30 days and the longer-term postinfusion period.

Experts discuss how the safety profiles of various chimeric antigen receptor (CAR) T-cell therapies influence final selection, considering other patient and disease factors that may affect the decision and how the multidisciplinary team communicates on procedural issues, clinical decisions, responsible parties, and next steps in the CAR T-cell therapy process, as well as the routine adoption of tumor burden–guided dosing following patient reevaluation and lymphodepletion.

Experts discuss the steps taken to ensure optimal T-cell persistence with chimeric antigen receptor (CAR) T-cell therapy, exploring the underlying mechanisms of toxicity and T-cell exhaustion and the advantages of fast off-rate kinetics, defining durable remission post CAR T-cell therapy, and sharing their views on the benefits and risks of approved CAR T-cell therapies for adult patients with relapsed or refractory B-cell acute lymphoblastic leukemia (B-ALL).

Experts discuss the routine initiation of bridging therapy between leukapheresis and chimeric antigen receptor (CAR) T-cell infusion at their center; the pharmacist’s role in implementing this procedure; collaboration with the team on agent choice, dosage, and administration; and monitoring for disease control and adverse events as well as the observed impact of bridging therapy on outcomes post CAR T-cell therapy.

Experts discuss the chimeric antigen receptor (CAR) T-cell treatment paradigm at Moffitt Cancer Center, exploring how treatment sequencing differs for Philadelphia chromosome–positive vs –negative acute lymphoblastic leukemia (ALL), varying risk factors, extramedullary disease, disease bulk, and bone marrow blast percentage, as well as how prior therapies such as blinatumomab and inotuzumab affect treatment selection for adult patients with CD19-positive or CD22-positive relapsed or refractory disease and the influence of clinical trial data on patient care.

Experts discuss the timing and process of obtaining molecular profiles for genetic variants and T-cell biomarkers during patient assessment, including the team member responsible for ordering the test and whether Moffitt Cancer Center uses a preferred assay for adult patients with relapsed or refractory B-cell acute lymphoblastic leukemia (B-ALL).

Experts discuss their distinct roles in patient eligibility, management, and follow-up for chimeric antigen receptor (CAR) T-cell therapy treatment in adult patients with precursor B-cell acute lymphoblastic leukemia (B-ALL), focusing on assessment, treatment planning, and ongoing care.