OncoTargets and Therapy (Mar 2023)
A Review of CAR-T Therapy in Pediatric and Young Adult B-Lineage Acute Leukemia: Clinical Perspectives in Singapore
Abstract
Michaela S Seng,1,2 Amandine C Meierhofer,3 Francesca L Lim,2,4 Shui Yen Soh,1,2 William YK Hwang2,4,5 1Department of Paediatric Hematology and Oncology, KK Women’s and Children’s Hospital, Singapore; 2Duke-NUS Medical School, Singapore; 3Heriot-Watt University, Edinburgh, Scotland; 4Department of Hematology, Singapore General Hospital, Singapore; 5National Cancer Centre Singapore, SingaporeCorrespondence: William YK Hwang, Department of Haematology, Singapore General Hospital, 31 Third Hospital Ave, 168753, Singapore, Tel +65 62223322, Email [email protected]: Approximately 10– 15% of pediatric B-cell acute lymphoblastic leukemia (B-ALL) are high risk at diagnosis or relapsed/ refractory. Prior to the availability of chimeric antigen receptor T-cell (CAR-T) in Singapore and the region, the treatment options for these paediatric and young adults are conventional salvage chemotherapy or chemo-immunotherapy regimens as a bridge to allogeneic total body irradiation-based hematopoietic stem cell transplantation (allo-HSCT). This results in significant acute and long-term toxicities, with suboptimal survival outcomes. Finding a curative salvage therapy with fewer long-term toxicities would translate to improved quality-adjusted life years in these children and young adults. In this review, we focus on the burden of relapsed/refractory pediatric B-ALL, the limitations of current strategies, the emerging paradigms for the role of CAR-T in r/r B-ALL, our local perspectives on the health economics and future direction of CAR-T therapies in pediatric patients.Keywords: cell therapy, relapsed, refractory, lymphoblastic leukemia, pediatric and young adult
