SOHO 2021 | The latest research in ALL cellular therapy
Stephan Grupp, MD, PhD, of the Children’s Hospital of Philadelphia, Philadelphia, PA, shares the latest updates in the field of acute lymphoblastic leukemia (ALL), and suggests how data can be used to improve treatment methods. Cellular therapies such as tisagenlecleucel have demonstrated significant reduction in intensive care unit admission rates, producing favorable toxicity profiles. Dr Grupp also talks on the loss of CD19 in CD19-negative relapsed patients, a challenging issue which studies are currently addressing with other targeted therapies. This interview took place during the ninth annual meeting of the Society of Hematologic Oncology (SOHO 2021) congress.
Transcript (edited for clarity)
What we were talking about at the meeting, and now the virtual meeting… sorry not to be there in person… is progress that’s been made since FDA approval with cell therapy for ALL. That was the first FDA approval for kids and young adults up to age 25 and that’s still the current only FDA approved therapy, cell therapy, for ALL. There are others in development, but that’s what’s approved by the FDA...
What we were talking about at the meeting, and now the virtual meeting… sorry not to be there in person… is progress that’s been made since FDA approval with cell therapy for ALL. That was the first FDA approval for kids and young adults up to age 25 and that’s still the current only FDA approved therapy, cell therapy, for ALL. There are others in development, but that’s what’s approved by the FDA. I think there’s been a lot of interest in the issue of toxicity control that has gotten considerably better in the years since the registration trial and the FDA approval. And you can see that in the real-world data where the risk of more significant CRS grade three and four… generally that puts you in the intensive care unit… is down from almost half of the patients on the registration trial for KYMRIAH or tisagenlecleucel to 16% now. And we’ve seen the same thing in our own hospital going from 40% ICU admission rates down to 12% at our hospital over the 400 patients that we treated.
So, I think that that… seeing that improvement I think is great. We have just reported on a study where we are giving prophylactic, or rather preemptive tocilizumab, and the circumstances are high disease burden over 40% blasts. As soon as the patient gets a fever, single dose of toci, and seen that significantly decrease but not completely remove the risk of a grade four CRS. So, that seems to work without increasing ICANS in using the cell therapy product tisagenlecleucel.
And I think that the final issue that we’re sort of looking at is the issue of how to deal with the relapse risk where the ALL loses CD19, the target for CTL019, or tisagenlecleucel, or KYMRIAH. And if that happens, is there something we can do? We can treat these patients with a CD22 CAR. But, we’d really like to prevent that CD19 escape and there are a number of studies underway trying to address that issue.
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Disclosures
Stephan Grupp, MD, PhD, has participated in consultancy work with and received research support from Novartis.
