Dr. Perl Discusses Upcoming CAR T-Cell Therapies for ALL

Alexander E. Perl, MD, associate professor of medicine, University of Pennsylvania, discusses upcoming chimeric antigen receptor (CAR) T-cell therapies for patients with acute lymphoblastic leukemia (ALL).

There has been interest in patients who lose response to CAR T-cell therapy, says Perl. One mechanism of resistance has been the loss of expression of the target of the CAR T cells. Many of those patients lack CD19, which has been the target of the cells that were generated.

Investigators have begun investigating whether 2 CAR T cells are needed, one directed against an antigen like CD19, the other against a second antigen, or whether a fallback option for the cells that do grow despite the T-cell therapy be better? Early data have looked at CD22, which is also commonly expressed in patients with ALL, but they are not as far along as data with CD19.

The development of CAR T-cell therapy has been particularly interesting in myeloma, says Perl. There has been some development of CAR T cells targeting CD19, but B-cell maturation agent (BCMA) has been the main area of development.