50 research outputs found
Treatment of Adult Patients with Relapsed/Refractory B-Cell Philadelphia-Negative Acute Lymphoblastic Leukemia
The majority of adult patients affected by B-cell acute lymphoblastic leukemia (B-ALL) will relapse after an initial response,
while approximately 20% will display primary resistant disease. Patients suffering from relapsed/refractory B-ALL have a very
poor outcome. Allogeneic hematopoietic cell transplantation (HCT) still represents the only curative approach, but is not so
frequently feasible, because of patient’s fitness, donor availability, and the ability to achieve a remission prior to HCT. The estimated
remission rates with conventional cytotoxic agents are around 30%, but they are short-lived. These disappointing results
led to the introduction of new immunologic-based treatments—blinatumomab and inotuzumab. They produced a substantial
improvement in terms of response rates, with the ability, in most cases, to induce a minimal residual disease (MRD)-negative status.
Similarly, T cells engineered to express a CD19-specific chimeric antigen receptor (CAR-T) have yielded sensational results
among patients with relapsed/refractory B-ALL, with unexpectedly high MRD-negative complete remissions rates. However,
the first studies looking at long-term outcomes after CAR-T infusions told us that a significant fraction of such responses are not
durable, and may benefit from a consolidation approach such as an allogeneic HCT