Alfred L. Garfall, MD
Chimeric antigen receptor (CAR) T-cell therapy has been progressing through clinical trials in various hematologic malignancies over the past 5 years. Response among malignancies has varied, though.
during the meeting, Garfall discussed the latest developments with CAR T-cell therapy in hematologic malignancies.
OncLive: Could you give an overview of your presentation on CAR T cells?
The use of CAR T cells for hematologic malignancies is really a remarkable translational medicine story that has played out over the past 20 years. It has really come into clinical application in the last 5 years, initially with pilot studies and now there are several multisite studies for different B-cell malignancies targeting CD19 with CAR T cells. Currently, we are moving into other targets besides CD19, such as BCMA for multiple myeloma, and we may even see the first FDA approval of a CAR T-cell therapy in the next 1 to 2 years.
I also focused on the use of CAR T cells for multiple myeloma. This is a promising area for which we have data over the last few months on studies that have come out of 3 different institutions including our own targeting BCMA, a novel target in multiple myeloma. An important demonstration of the potential for CAR T cells targeting antigens other than CD19, which is where most of the work has been done so far.
What responses are seen with each malignancy?
The studies have now progressed to the point where there are enough patients treated in these different diseases in different centers to ascertain some patterns of response and resistance. There are 2 interesting patterns that have emerged if you look at CLL and ALL as opposite ends of the spectrum. In B-acute lymphoblastic leukemia, there are very high response rates—over 90% response rates—in patients who are refractory to all available therapies. But, a sizable portion of them—about 25% to 50%—will relapse and, in most cases, those relapsed patients will have CD19-negative disease. So, the leukemia has managed to downregulate or eliminate the target of the CAR T cell.
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