HOW I TREAT| MARCH 12, 2020
How I treat adults with advanced acute lymphoblastic leukemia eligible for CD19-targeted immunotherapyIbrahim Aldoss , Stephen J. Forman
Blood (2020) 135 (11): 804–813.
https://doi.org/10.1182/blood.2019002132
AbstractCD19-targeted immunotherapies have drastically improved outcomes for relapsed/refractory (r/r) B-cell acute lymphoblastic leukemia (ALL) patients. Such therapies, including blinatumomab and CD19 chimeric antigen receptor (CD19CAR) T cells, yield high remission rates and can bridge to more definitive consolidation therapy with curative intent. Both treatments are approved by the US Food and Drug Administration (FDA) for r/r ALL (CD19CAR T-cell approval is restricted to patients ≤25 years old). Although availability of blinatumomab and CD19CAR T cells has extended options for the treatment of r/r ALL, prioritizing the sequence of these agents on an individual-patient basis may be difficult for the treating physician. Considering each therapy’s advantages, limitations, and challenges is necessary when choosing between them. Although patients may receive both blinatumomab and CD19CAR T cells sequentially in cases that fail to respond or subsequently relapse, a proportion of patients treated with CD19-targeted immunotherapy will lose expression of CD19 and will be excluded from receiving the alternative CD19-targeted therapy. Thus, weighing all considerations for each patient before selecting a CD19-targeted immunotherapy is crucial. Here, we discuss real-life scenarios of adults with r/r ALL, in which we selected either blinatumomab or CD19CAR T-cell therapy, and the rationale behind each decision.
Subjects:
How I Treat, Immunobiology and Immunotherapy, Lymphoid Neoplasia
Topics:
blinatumomab, cd19 antigens, immunotherapy, t-lymphocytes, acute lymphocytic leukemia, t-cell therapy, chimeric antigen receptors, disease remission
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