Relapse Management and Role for Consolidative Hematopoietic Stem Cell Transplantation Following CAR T-Cell Therapy *

Introduction

Treatment strategies for children and young adults with relapsed and/or refractory acute lymphoblastic leukemia (ALL) have evolved significantly, from a historical reliance on intensive combination antineoplastic therapy to targeted genetically modified cell-based therapies. Hundreds of trials utilizing CAR T-cells are currently ongoing globally. In fact, the success of CAR T-cells in clinical trials has led to the FDA approval of tisagenlecleucel and axicabtagene ciloleucel for use in relapsed refractory cases of children with ALL and/or adults with lymphoma. While the results for inducing remission in this high-risk patient population are impressive, long-term durable remissions are achievable in only a fraction of patients. This section will focus on relapses post-CAR T therapy, efficacy of second infusions, alternative CAR targets, and the role of consolidative allogeneic bone marrow transplant post-CAR T therapy.