Stem cell transplants may significantly reduce their chances of relapse in children and young adults with acute lymphoblastic leukaemia who received CAR T-cell therapy.
New research, published in The Journal of Clinical Oncology, details the longest reported follow-up in children and young adults with B-cell acute lymphoblastic leukaemia after CD19-CAR T-cell therapy.
'As impactful as CAR T-cell therapy is for children with relapsed leukaemia, we now know that the best outcomes happen when the child undergoes a stem cell transplant afterwards,' said author Dr Daniel Lee, director of paediatric stem cell transplant and immunotherapy at the University of Virginia Children's Hospital.
CAR (chimeric antigen receptor) T-cell therapy uses the patient's own immune cells and modifies them to improve their cancer-killing abilities. Acute lymphoblastic leukaemia is the most common childhood cancer and CAR T-cell therapy has been shown to achieve complete remission in 60 to 100 percent of patients. Limited data suggests, however, that a significant number of patients relapse after treatment, with one study finding that more than 40 percent of patients relapsed 13 months after CAR T-cell treatment.
In this study, the researchers recruited 50 children and young adults with acute lymphoblastic leukaemia between the ages of four and 30. All patients were treated with CAR T-cell therapy, with 21 receiving donor stem cell transplants after their CAR-T cell therapy. While all patients who only received CAR T-cell therapy relapsed within 24 months, under ten percent of the patients who also had a stem cell transplant did.
'Many parents turn to CAR T-cells to possibly avoid a stem cell transplant, and that is entirely understandable,' said Dr Lee. 'We should do all we can to maximize the chance for a cure, and right now that means a transplant after CAR therapy for most.'
Stem cell transplants can have serious associated risks, and the researchers hope that in the future it will be possible to identify which children and young adults will benefit from a follow-up transplant after CAR T-cell therapy and those who do not.