Consensus recommendations for CAR T-cell therapy in R/R B‑ALL

Results from a modified Delphi study, developing consensus recommendations on chimeric antigen receptor (CAR) T-cell therapy administration in adults with relapsed/refractory (R/R) B-cell acute lymphoblastic leukemia (B-ALL), were published in Blood by Muffly et al. A panel of nine principal investigators from the Real World Outcomes Collaborative of CAR T-cell Therapy in Adult ALL (ROCCA) consortium evaluated 58 initial recommendation statements, subsequently validated by 27 additional ROCCA investigators. 

Key data: Following two panel meetings and external validation, 33 of 34 panel consensus statements were retained (≥75% agreement). The panel strongly recommended referral for CAR T-cell therapy for all interested patients with R/R B-ALL, regardless of leukemia burden, site of disease, or age. CAR T-cell therapy selection should be guided by patient factors, clinical experience, and product characteristics. Bridging therapy is recommended, particularly in patients with morphologic bone marrow and/or extramedullary disease (EMD). Outpatient administration is conditionally supported, provided institutions are adequately equipped. Routine immune reconstitution monitoring, anti-seizure prophylaxis, minimal residual disease (MRD)-based response assessment, and transplant referral for transplant-naïve patients, ideally within 6 months of CAR T-cell therapy, were also recommended.

Key learning: These consensus recommendations provide practical, validated guidance for clinicians administering commercial CAR T-cell therapy to adults with R/R B-ALL, addressing critical knowledge gaps in the absence of randomized trials.