CAR T-cell Therapy

Standard treatment approaches for patients with chronic lymphocytic leukemia will continue to include fludarabine, cyclophosphamide, and rituximab and allogeneic stem cell transplantation.

Patients with advanced lymphoid malignancies have had few treatment options, particularly those with extensive, refractory disease. Allogeneic or autologous hematopoietic stem cell transplantation has been one life-prolonging and potentially curative option for these patients, but these procedures are associated with various toxicities and are not appropriate for all patients, with older adults and those with great- er disease burden often excluded as candidates.

Novel agents being explored in the landscape of both peripheral and cutaneous T-cell lymphomas could lead to an expansion of treatment options for patients.

Treatment with KTE-C19 demonstrated an objective response rate of 79% and a complete remission rate of 52% for patients with aggressive, chemorefractory non-Hodgkin's lymphoma.

Chimeric antigen receptor T-cell therapy targeting CD19 demonstrated a nearly 80% complete remission rate across relapsed/refractory B-cell acute lymphoblastic leukemia patients with multiple levels of disease burden.

Despite multiple therapeutic advances in recent years, proteasome inhibitors remain a cornerstone of therapy for multiple myeloma, both newly diagnosed and relapsed and refractory disease.

Chimeric antigen receptor T-cells offer highly effective therapy for patients with minimal residual disease or bulky disease in both aggressive and indolent B-cell non-Hodgkin lymphomas.

The CD19-targeting CAR T-cell therapy CTL019 induced responses in 53% of patients with relapsed/refractory chronic lymphocytic leukemia, including complete remissions in 35% of patients.

Three-fourths of patients with advanced lymphoma achieved durable objective responses to treatment with chimeric antigen receptor T-cell therapy targeting CD19 even after a low-dose chemotherapy conditioning regimen.

Chimeric antigen receptor-modified T-cell therapies have demonstrated durable complete responses for patients with relapsed/refractory B-cell acute lymphoblastic leukemia; however, several questions remain regarding their optimal use and applicability outside of this disease.

Treatment with allogeneic anti–CD19 chimeric antigen receptor–modified T cell therapy induced complete remissions in 30% of patients with advanced progressive B-cell malignancies without causing graft-versus-host disease.

Krishna Komanduri, MD, professor of Medicine, Microbiology, and Immunology, director, Sylvester Adult Stem Cell Transplant Program, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, discusses future treatments for patients with hematologic malignancies.