EBMT 2023 | GoCART ongoing projects: impact of prior therapy & alloSCT consolidation on CAR-T outcomes in ALL

The study that we are conducting at the GoCART coalition tries to analyze two main aspects regarding relapsed/refractory ALL that arrived to a CAR T-cell treatment. So, there’s very a big interest in knowing [what] is the impact of preceding therapy. So, there are a lot of things that we have learned in the past years regarding how the patients can arrive to CAR T-cell treatment; preceding therapy may have a great impact on this. We know that the tumor burden, for instance, is really important for the chance of response and the duration of response. But there is still a lot of remaining unanswered questions that we want to do with this multinational analysis of retrospective data of patients with AML receiving CAR T-cell therapy. What we want to see is how the different types of bridging therapy or precision therapy like modern therapies, like blinatumomab or inotuzumab have an impact on the safety and the efficacy of CAR T-cells. But not only this kind of immunotherapy, but also other bridging strategies like chemotherapy high dose, low dose chemotherapy, radiation, TKIs. So there are a lot of possibilities that we really want to analyze a big portion of patients treated with CAR T-cells and try to draw conclusions to provide an evidence based guideline for these patients arriving to CAR T-cells. The second part of this study is also the burning question of “which is the role of allogenic stem cell transplant after achieving complete remissions after CAR T-cells?”. So acute lymphoblastic leukemia, relapsed/refractory ALL, has a very dismal prognosis. So even patients that achieve complete remission after CAR-T retain a very high risk of relapse. So, a real burning question in the scientific community is how can we manage to reduce the risk of relapse? An obvious strategy is to try to consolidate this response with an allogenic stem cell transplant. But the fact is, we don’t really know if doing this will really decrease the risk of relapse or if the promise of a reduction in the risk of relapse overcomes the risk of increased treatment-related mortality. So, with this multinational center study, we want to analyze a very big amount of patients, a very big sample size of patients, and see how really in the real world setting how the performance or not performance of these types of consolidations really impact the outcomes, the survival of CAR T-cell patients. So we now we have this study open, we are gathering data, and maybe by the end of the year we will have some information regarding this very important question for our patients.