EHA 2019 | CAR T-cells for ALL

Ulrich Jäger

Ulrich Jäger, MD, Medical University of Vienna, Vienna, Austria, discusses the use of CAR T-cells for ALL and what the future holds for the treatment of the disease with CAR T-cell therapy. This interview took place at the 24th Congress of the European Hematology Association (EHA) 2019, held in Amsterdam, Netherlands.

Transcript (edited for clarity):

There is a whole new field opening up with the advent of CAR T-cells. What we are trying to do now is to consolidate the field on the basis of the data that we have generated. Of course, in the development of new fields, there’s always a hype in the beginning. Right now, we are a bit beyond this hype, I guess, and we are trying to make sense out of what we’ve seen. So I think we can clearly state that in pediatric ALL and in young adults, we achieve a high rate of remission with the CAR T-cells, in patients who have been treated with allogenic transplant, for instance. In these patients, the question is really, can we sustain these high remission rates that we have, and where will CAR T-cells be placed? Will they be bridging to another allo transplant treatment, et cetera, so that’s a big question.

In the ALLs, we also have some idea on how resistance develops, because many of these patients developed CD19 mutations and then the CAR T-cells don’t work anymore. So there is a field of research. In the diffused large B-cell lymphomas we can expect that we can probably cure, or let’s say achieve long-term remissions, in 30-40% of the patients. But that also means that more than half of the patients do not respond or have relapses, and that’s where we have to work on. So most of the research goes into breaking resistance; how can we make the CAR T-cells more effective? We will hear a lot about these things at this meeting. So there is a lot of questions coming up. The field will be going into expanding to other indications.

We will get novel CAR technologies. The CARs will improve over time, and we have to put this into clinical trials and make it available for patients. I should also say that we are in an era where we have two of these products available for routine treatment, and there it’s also important to have, let’s say, national and international guidelines. Who should get these cells? Who is eligible? How do we select patients? Can we, by better patient selection, for instance, make more economic sense out of what we do? And how can we sustain these treatments? Those are the major questions. I will give a talk on this tomorrow and I will cover mainly those fields. So where are we now (status quo)? What are the problems, and can we establish a road map for research?

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