CAR T-Cell Therapies in Relapsed/Refractory Acute Lymphocytic Leukemia

This OncLive Insights program featured Drs. Lori Muffly and Jae Park discussing CAR T-cell therapy evolution in relapsed/refractory acute lymphoblastic leukemia (ALL). Key topics included individualized treatment sequencing considering prior therapy history, disease burden, and transplant candidacy rather than algorithmic approaches. The physicians addressed common concerns about inotuzumab veno-occlusive disease risk and CAR T-transplant sequencing, emphasizing that CAR T should not be limited to non-transplant candidates. Durability assessment varies by product, with minimal residual disease negativity and B-cell aplasia serving as indicators for 4-1BB-containing products, whereas persistence monitoring provides additional guidance. Toxicity profiles differ significantly between brexucabtagene autoleucel (brexucel) and obecabtagene autoleucel (obe-cel), with the latter demonstrating substantially lower severe cytokine release syndrome and neurotoxicity rates, expanding treatment candidacy. Future directions focus on moving CAR T-cells to earlier treatment lines as definitive therapy, reducing chemotherapy exposure duration. Emerging innovations include CD7 CARs for T-cell ALL addressing critical unmet needs, and in vivo CAR development improving patient access through reduced hospitalization and collection requirements while maintaining efficacy.