Dr. Perl Discusses the Impact of CAR T-Cell Therapy on ALL

Alexander E. Perl, MD, associate professor of medicine, University of Pennsylvania, discusses the impact of chimeric antigen receptor (CAR) T-cell therapy on the treatment of patients with acute lymphoblastic leukemia (ALL).

Historically, there has not been an effective salvage therapy for patients with ALL. The CD19-directed therapies have changed that process, whether it is with blinatumomab (Blincyto) or CAR T-cell therapies, explains Perl.

There are high rates of response and durable responses with CD19-directed therapies. With CAR T-cell therapy, not all patients with ALL need a subsequent transplant because patients who achieve durable responses and persistence of their CAR T cells can live in sustained remissions without additional therapy.

According to Perl, patients who have had salvage therapy and have not responded continue to respond to CAR T-cell therapy. Having a different mechanism of modality has changed the treatment landscape for this patient population.

The FDA approved tisagenlecleucel (Kymriah) in patients with ALL back in August 2017. Investigators concluded that tisagenlecleucel was associated with clinically meaningful remissions. The estimated relapse-free rate among responders at month 6 was 75.4% (95% CI, 57.2-86.7). The median duration of response was not reached at a median follow-up of 4.8 months.