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What is the Role of Hematopoietic Cell Transplantation (HCT) for Pediatric Acute Lymphoblastic Leukemia (ALL) in the Age of Chimeric Antigen Receptor T-Cell (CART) Therapy?

Taraseviciute, Agne MD, PhD*; Broglie, Larisa MD, MS; Phelan, Rachel MD, MPH; Bhatt, Neel S. MD, MPH§; Becktell, Kerri MD; Burke, Michael J. MD

Journal of Pediatric Hematology/Oncology: July 2019 - Volume 41 - Issue 5 - p 337–344
doi: 10.1097/MPH.0000000000001479
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CD19 chimeric antigen receptor T-cell (CART) therapy has revolutionized the treatment of patients with relapsed/refractory hematologic malignancies, especially B-cell acute lymphoblastic leukemia. As CART immunotherapy expands from clinical trials to FDA-approved treatments, a consensus among oncologists and hematopoietic cell transplant (HCT) physicians is needed to identify which patients may benefit from consolidative HCT post-CART therapy. Here, we review CD19 CART therapy and the outcomes of published clinical trials, highlighting the use of post-CART HCT and the pattern of relapse after CD19 CART. At this time, the limited available long-term data from clinical trials precludes us from making definitive HCT recommendations. However, based on currently available data, we propose that consolidative HCT post-CART therapy be considered for all HCT-eligible patients and especially for pediatric patients with KMT2A-rearranged B-cell acute lymphoblastic leukemia.

*Division of Pediatric Hematology, Oncology and Blood and Marrow Transplantation, Children’s Hospital Los Angeles, Los Angeles, CA

Division of Pediatric Hematology-Oncology-Stem Cell Transplant, Columbia University Medical Center, New York, NY

Division of Pediatric Hematology-Oncology, Medical College of Wisconsin, Milwaukee, WI

§Department of Oncology, St. Jude Children’s Research Hospital, Memphis, TN

A.T. and L.B. contributed equally to this work.

Supported by the Midwest Athletes Against Childhood Cancer (MACC) Fund and by the National Center for Advancing Translational Sciences, National Institutes of Health, through Grant Numbers UL1TR001436 and 1TL1TR001437 (L.B.).

The authors declare no conflict of interest.

Reprints: Agne Taraseviciute, MD, PhD, Children’s Hospital Los Angeles, 4650 Sunset Blvd. #54, Los Angeles, CA 90027 (e-mail: ataraseviciute@chla.usc.edu).

Received October 31, 2018

Accepted February 24, 2019

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