What are the challenges of sequencing immunotherapies in adults with ALL?

During the 2023 Society of Hematologic Oncology Congress (SOHO), the ALL Hub spoke to Bijal Shah, Moffitt Cancer Center, Tampa, US. We asked, What are the challenges of sequencing immunotherapies in adults with acute lymphoblastic leukemia (ALL)?

First, Shah discussed the sequencing approach with immunotherapies in B-cell ALL, including the use of blinatumomab in newly diagnosed adult patients; this is based on positive results from the ECOG ACRIN E1910 trial. The results indicated its potential future use as a component of a multi-agent therapy for most adult patients. He then highlighted the promising data on inotuzumab ozogamicin (InO), highlighting the safety and clinical benefit of mini-CVD plus InO in older adults with B-ALL.

For the remainder of the discussion, Shah talks about the use of chimeric antigen receptor (CAR) T-cell therapy, including how prior exposures to either blinatumomab, InO, or both, can affect outcomes. He also discusses the use of immunotherapies as salvage after CAR T-cell therapy failure, and the incorporation of CAR T-cell therapy into earlier lines of therapy. To close, he emphasises the need for caution when sequencing immunotherapies, given most patients with refractory disease have a high disease burden. Currently, there are several ongoing studies investigating novel immunotherapies aiming to shift the treatment paradigm, prolong survival, and cure a higher proportion of patients with ALL.