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Treatment Sequencing Decisions for B-ALL: Perspectives From Moffitt Cancer Center

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.

Video content above is prompted by the following:

From the perspective of coordination of care, what characteristics of patient, disease, and/or CAR T-cell construct are considered when determining if a patient achieving an MRD-negative CR post CAR T-cell therapy should proceed to consolidative SCT?

  • Under which circumstances could CAR T-cell therapy be considered a standalone treatment?
  • In your professional experience, what are the principal risk factors for relapsed disease and what are some feasible prevention or mitigation strategies?
  • How does early T-cell exhaustion affect the decision to proceed with allo-HSCT in previous recipients of CAR T-cell therapy for relapsed or refractory B-cell acute lymphoblastic leukemia (B-ALL)?
  • In addition to T-cell exhaustion, what other factors drive that decision?

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