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COSTEM 2021 | Benefits of post CAR-T alloHSCT consolidation therapy in B-ALL

While patients with B-cell acute lymphoblastic leukemia (B-ALL) treated with chimeric antigen receptor (CAR) T-cell therapy usually experience high initial complete response rates (CRR), the risk of relapse post CAR-T remains a major concern. Peihua Lu, MD, Beijing Lu Daopei Institute of Hematology, Beijing, China, and Hebei Yanda Lu Daopei Hospital, Langfang, China, discusses the benefit of consolidation with allogeneic hematopoietic stem cell transplantation (alloHSCT) after CAR T-cell therapy in patients with B-ALL. Previous data has shown that both pedatric and adult patients are able to achieve a long-term disease-free survival (DFS) and overall survival (OS) ranging between 40-50% after CAR T-cell therapy, depending on measurable residual (MRD) status and leukemia burden. Indeed, high-risk patients with high disease burden have a much lower duration of response (DOR) than patients with low disease burden and MRD negativity. Recently, numerous lines of evidence have demonstrated that in patients in complete remission after CAR T-cell therapy, alloHSCT can further improve the durability of remission. Importantly, the 2-year leukemia-free survival (LFS) in patients with B-ALL who do not undergo alloHSCT consolidation post CAR-T was reported to be 27% in comparison to 60% in patients receiving alloHSCT. Dr Lu explains that since the benefit of alloHSCT consolidation therapy is the highest in high-risk patients, it is important to perform individual assessments to identify patients who are more likely to benefit from this therapy. This interview took place at the 6th Congress on Controversies in Stem Cell Transplantation and Cellular Therapies (COSTEM), which took place virtually.