The present and future for CAR-T cell therapy in adult B-cell ALL

Chimeric Antigen Receptor T-cell therapy (CAR-T) targeting CD19 has transformed the management of relapsed/refractory (r/r) B-Acute Lymphoblastic Leukemia (B-ALL), with FDA approval of tisagenlecleucel (tisa-cel) for pediatric/young adult patients and brexucabtagene autoleucel (brexu-cel) for adults. Efficacy is contingent upon several factors including disease burden. Emerging data suggests that bridging therapy, lymphodepletion and for some patients, consolidation therapy have an important role in the success of treatment. Further, strategies to define and manage immunotoxic side effects including hematotoxicity is critical to safe delivery. Advancements in CAR-T design beyond CD19 represent an ongoing therapeutic evolution. Overall, CAR-T therapy signifies a paradigm shift in B-ALL management, with the potential for improved remission and survival in a historically challenging patient population.