Dr. Deol on the Utility of Tisagenlecleucel in ALL

Abhinav Deol, MD, an associate clinical professor of Barbara Ann Karmanos Cancer Institute at Wayne State University, discusses the approval of the CAR T-cell therapy tisagenlecleucel (tisa-cel; Kymriah) for pediatric patients with acute lymphoblastic leukemia (ALL).

The original trial with tisagenlecleucel examined its use in pediatric patients with ALL, with subsequent studies including young adults up to the age of 25 years, says Deol. Currently, tisagenlecleucel is indicated for patients with ALL who have relapsed/refractory disease and are 25 years of age or younger; the agent in not approved for older patients at this time.

Patients have achieved good responses with the CAR T-cell product, with higher rates of cytokine release syndrome and neurotoxicity compared with the lymphoma population. These results might correlate with the disease burden the patient has before starting the CAR T-cell therapy. Investigators are working on achieving the optimal amount of disease by doing cytoreduction prior to CAR T-cell therapy to improve outcomes, Deol adds. Overall, the responses achieved with this approach appear to be stable, according to Deol.

Over the past few years, data have indicated that the use of CAR T-cell therapy in the pediatric population could potentially be curative, as some patients have achieved long-term complete responses (CRs) and have not relapsed, says Deol. In older patients, some achieve a CR with this approach might require subsequent allogeneic stem cell transplant to increase their likelihood of staying in remission, explains Deol.

Chinese investigators and researchers at Fred Hutch Cancer Research Center have demonstrated that older patients who underwent allogeneic stem cell transplant after CAR T-cell therapy had better long-term disease control compared with those who did not receive CAR T cells for ALL, concludes Deol.