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Optimizing bridging therapies to CAR-T for children and young adults with R/R ALL
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CAR T-cell therapies have emerged as an effective treatment option for patients with R/R B-ALL. In the period between CAR T-cell eligibility and infusion, disease progression poses a significant risk, necessitating the use of bridging therapy to optimize outcomes.1 High-intensity bridging therapies are often used in patients with a higher tumor burden; however, their potential benefits need to be evaluated against increased treatment-related toxicities. The impact of different bridging therapies prior to anti-CD19 CAR T-cell infusion was evaluated in a multinational retrospective study, comparing no systemic therapy, low-intensity, and high-intensity therapy in terms of OS, PFS, tumor burden, and adverse events in children and young adults (N = 88) with R/R B-ALL.1 Results from this analysis were published in the Journal of Hematology and Oncology by Breidenbach et al.1 |
| Key learnings |
| OS was significantly improved in patients who received no bridging therapy compared to those who received low- (p = 0.0297) or high-intensity (p = 0.0307) bridging therapy. There was no significant difference in PFS among the groups. |
| Patients who received high-intensity bridging therapy experienced increased adverse events, including a higher rate of bacterial infections (p = 0.0052) and mucositis (p= 0.0108). |
| Patients receiving high-intensity bridging therapy had a higher tumor burden and higher MRD at baseline compared to the low-intensity/no therapy group. |
| These data suggest that low-intensity bridging may be preferable when clinically feasible, particularly in patients with manageable tumor burden; necessitating prospective studies to optimize bridging therapy in R/R B-ALL. |
Abbreviations: B-ALL, B-cell lineage acute lymphoblastic leukemia; CAR, chimeric antigen receptor; MRD, measurable residual disease; OS, overall survival; PFS, progression-free survival; R/R, relapsed/refractory.
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