HEMATOPOIETIC STEM CELL TRANSPLANTATION: Edited by Christine DuncanRole of chimeric antigen receptor T-cell therapy: bridge to transplantation or stand-alone therapy in pediatric acute lymphoblastic leukemiaQayed, Munaa,∗; Bleakley, Marieb,c,∗; Shah, Nirali N.d,∗Author Information aAflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, and Emory University, Atlanta, GA bClinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington cDepartment of Pediatrics, Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington dPediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA Correspondence to Nirali N. Shah, MD, MHSc, Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA. Tel: +240 760 6199; e-mail: [email protected] Current Opinion in Hematology: November 2021 - Volume 28 - Issue 6 - p 373-379 doi: 10.1097/MOH.0000000000000685 Buy Metrics Abstract Purpose of review To discuss the curative potential for chimeric antigen receptor T-cell (CAR-T) therapy, with or without consolidative hematopoietic stem cell transplantation (HCT) in the treatment of children and young adults with B lineage acute lymphoblastic leukemia (B-ALL). Recent findings CAR-T targeting CD19 can induce durable remissions and prolong life in patients with relapsed/refractory B-ALL. Whether HCT is needed to consolidate remission and cure relapse/refractory B-ALL following a CD19 CAR-T induced remission remains controversial. Preliminary evidence suggests that consolidative HCT following CAR-T in HCT-naïve children improves leukemia-free survival. However, avoiding HCT-related late effects is a desirable goal, so identification of patients at high risk of relapse is needed to appropriately direct those patients to HCT when necessary, while avoiding HCT in others. High disease burden prior to CAR-T infusion, loss of B-cell aplasia and detection of measurable residual disease by flow cytometry or next-generation sequencing following CAR-T therapy associate with a higher relapse risk and may identify patients requiring consolidative HCT for relapse prevention. Summary There is a pressing need to determine when CD19 CAR-T alone is likely to be curative and when a consolidative HCT will be required. We discuss the current state of knowledge and future directions. Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.