COSTEM 2021 | Risks and indications for consolidation alloHSCT after CAR T-cell therapy in ALL

Peihua Lu, MD, Beijing Lu Daopei Institute of Hematology, Beijing, China, and Hebei Yanda Lu Daopei Hospital, Langfang, China, gives an overview of the results of a study exploring the risks associated with allogeneic hematopoietic stem cell transplantation (alloHSCT) consolidation therapy after chimeric antigen receptor (CAR) T-cell therapy in patients with acute lymphoblastic leukemia (ALL), and discusses current indications for consolidation with alloHSCT. Dr Lu explains that patients in complete remission after CAR T-cell therapy who received consolidation with alloHSCT did not experience a significant increase in severe acute or chronic graft-versus-host disease (GvHD), engraftment problems or transplant-related mortality when compared to patients who achieved complete remission after chemotherapy and received subsequent alloHSCT. Currently, it is recommended for patients to undergo alloHSCT within three months of complete remission from CAR T-cell therapy. In addition, high-risk patients achieving complete remission with measurable residual disease (MRD)-positive or negative disease should be offered alloHSCT. Nevertheless, Dr Lu highlights that as CAR T-cell therapies improve and enable patients to achieve a longer remission duration, these recommendations should be reevaluated. This interview took place at the 6th Congress on Controversies in Stem Cell Transplantation and Cellular Therapies (COSTEM), which took place virtually.