Stephan Grupp, MD, PhD, director, Cancer Immunotherapy Program, director, Translational Research for the Center for Childhood Cancer Research, medical director, Stem Cell Laboratory, Children’s Hospital of Philadelphia, discusses the placement of chimeric antigen receptor (CAR) T-cell therapy in the treatment of patients with acute lymphoblastic leukemia (ALL).

Currently, the CAR T-cell therapy tisagenlecleucel (Kymriah) has been approved by the FDA for the treatment of pediatric and young adult patients with relapsed or refractory ALL; however, physicians are hoping to bring it into earlier lines of therapy. In the past 5 or 6 years, referring physicians have been calling specialists earlier, notes Grupp. Patients who are referred early often have a lower disease burden, he adds.

The Children's Oncology Group is set to launch an international study to evaluate whether CAR T-cell therapy can be used as frontline therapy in patients who have not relapsed; these are high-risk patients who still have minimal residual disease after receiving 2 cycles of chemotherapy. Earlier introduction of CAR T-cell therapy may obviate the need for transplant, explains Grupp. The trial is set to open in the next month or two.

Videos

Dr. Grupp on the Optimal Setting of CAR T-Cell Therapy in ALL

Stephan Grupp, MD, PhD, director, Cancer Immunotherapy Program, director, Translational Research for the Center for Childhood Cancer Research, medical director, Stem Cell Laboratory, Children’s Hospital of Philadelphia, discusses the findings of the ELIANA trial.

Updated findings from the phase II ELIANA study of tisagenlecleucel (Kymriah) in pediatric and young adult patients with relapsed or refractory acute lymphoblastic leukemia (ALL) were presented at the 2018 ASH Annual Meeting. In this population, the CD19-targeted chimeric antigen receptor (CAR) T-cell therapy demonstrated sustained rates of relapse-free survival (RFS) and overall survival (OS) at 24 and 18 months.

The 24-month RFS rate with tisagenlecleucel was 62% (95% CI, 47%-75%). At months 12 and 18, the RFS rate was 66% (95% CI, 52%-77%). Additionally, the 12-month OS rate was 76% (95% CI, 65%-85%) with tisagenlecleucel and the 18-month OS rate was 70% (95% CI, 58%-79%). These pediatric and young adult patients had a high disease burden with overtly relapsed ALL, Grupp notes. The updated results show that these patients are staying in remission for a significant amount of time following infusion of this CAR T-cell therapy.

Stephan Grupp, MD, PhD, director, Cancer Immunotherapy Program, director, Translational Research for the Center for Childhood Cancer Research, medical director, Stem Cell Laboratory, Children’s Hospital of Philadelphia, discusses the findings of the ELIANA trial.
 

Dr. Grupp Discusses the Findings of the ELIANA Trial

Stephan Grupp, MD, PhD, of the Children’s Hospital of Philadelphia, discusses the optimal treatment settings for novel CD19-specific CAR-modified T cell therapies in patients with acute lymphoblastic leukemia (ALL).

CAR-modified T cell therapies have generated excitement, as novel treatments for patients with ALL. In updated findings from 39 pediatric patients with relapsed/refractory ALL, the complete remission rate was 92%. In this population, this is a good treatment option, Grupp notes.

Given the high-level of efficacy seen with upfront chemotherapy in pediatric patients, Grupp believes the CAR T cell therapies are best suited for later lines of treatment. However, in adult patients with ALL, approximately half of patients progress on frontline therapy. For this population, CAR T cell therapies could be beneficial in earlier settings. At this point, Grupp remains uncertain whether the novel immunotherapies could ever replace frontline chemotherapy in ALL.

View more from the 2014 ASH Annual Meeting

Stephan Grupp, MD, PhD, of the Children's Hospital of Philadelphia, discusses the optimal treatment settings for novel CD19-specific CAR-modified T cell therapies in patients with acute lymphoblastic leukemia.

Stephan Grupp, MD, PhD

Articles

Dr. Grupp on the Optimal Setting of CAR T-Cell Therapy in ALL

Dr. Grupp Discusses the Findings of the ELIANA Trial

Dr. Grupp on Optimal Treatment Settings for CAR-Modified T Cells