The discovery and development of chimeric antigen receptor T cells (CAR-T) cells for cancer immunotherapy has led to a paradigm shift in cancer management. Many professional medical societies have been closely involved in both the research and clinical aspects of CAR-T cells, however, ASBMT has taken a leadership role in various avenues of CAR-T cells including the society’s initiatives in health policy, clinical management and research.
Recently, the ASBMT issued a position statement on grading of cytokine release syndrome (CRS) and neurological toxicity due to immune effector cells. Subsequently, the society released a statement on the clinical aspects of management of acute lymphoblastic leukemia (ALL) with respect to CAR-T cells. The paper entitled “Clinical Utilization of Chimeric Antigen Receptor T Cells in B Cell Acute Lymphoblastic Leukemia: An Expert Opinion from the European Society for Blood and Marrow Transplantation and the American Society for Blood and Marrow Transplantation” is published online in both Biology of Blood and Marrow Transplantation and Bone Marrow Transplantation, and is a culmination of efforts of ASBMT and the EBMT. This paper is written by thought leaders in the field of cellular therapy from around the globe including the United States, France, United Kingdom, Germany, Israel, Saudi Arabia, Lebanon and Italy.
Since tisagenlecleucel (Kymriah), an anti-CD19 CAR-T cell therapy, was approved by the United States Food and Drug Administration (FDA) in 2017, many questions have arisen regarding its appropriate use around transplantation in B cell ALL in children and the adolescent and young adult (AYA) group. The clinical community practicing hematology has many questions in relation to the use of tisagenlecleucel both pre and post allogeneic transplantation, and also in regard to its short and long term toxicities. Moreover, sequencing tisagenlecleucel with other treatments has not been well described in the literature. Thus the authors, who included a mix of both CAR-T and ALL experts have prepared a treatment guide with respect to the timing of utilization of CAR-T cells in ALL both pre and post allogeneic transplantation. The paper is written in a top 10 question format focusing on and describing the clinical facets of disease management (and does not discuss pathobiology or research priorities).
ASBMT is extremely proud of the teamwork which made this collaboration between ASBMT and EBMT possible. The leadership from the Acute Leukemia Working Party of EBMT, ASBMT’s practice guidelines, education and cellular therapy committees helped in formulating the contents of the manuscript. We hope that this paper will be used as a clinical guide to address many unanswered questions in the ALL management paradigm with respect to CAR-T cells, and foster continued collaborative efforts with EBMT in future endeavors.