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New therapies will boost poor relapsed ALL outcomes

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Dr Larry Bacon

Consultant Haematologist at the National Allogenic Bone Marrow Transplant Unit, St James’s Hospital, Dublin

Antibody and CAR-T cell therapies are using the body’s own immune system to fight acute lymphoblastic leukaemia (ALL) – and it’s changing the game for people with relapsed and refractory disease.


A flurry of innovative new treatments are giving fresh hope to people facing relapsed or refractory lymphoblastic leukaemia (ALL).

Two new antibody therapies were given National Centre for Pharmacoeconomics backing in June, and the green light for chimeric antigen receptor T-cell (CAR-T) therapy is hoped for in the coming months.

It represents a huge step forward for previously difficult-to-treat patients, says Dr Larry Bacon, Consultant Haematologist at the National Allogenic Bone Marrow Transplant Unit in Dublin’s St James’s hospital.

“These drugs are hugely significant and represent a complete change in the landscape for the therapy of relapsed and refractory disease,” he says.

One of the drugs binds to both T-cells and ALL cells to boost immune response, and the other binds to cancer cells before unleashing a fatal chemical pay load. Both treatments induce remission in up to 80% of patients.

When the patient achieves remission, and they can be considered for bone marrow transplantation, the treatments act as a bridge to a bone marrow transplant, which would not be possible with active disease.

One of the new antibodies can lead to cytokine release syndrome or central nervous system toxicity, whereas veno-occlusive disease of the liver has been seen in patients treated by the other.

Another option for patients who previously have not been able to get into remission

CAR-T therapy, which genetically modifies the patients’ own T-cells to recognise and destroy leukaemia cells, can be used in relapsed disease either pre- or post-transplant.

Dr Bacon calls the treatments “a huge breakthrough.”

“Because CAR-T cell therapy is so new, we don’t know how much impact these drugs will have on patient outcomes. But it will be significant, as they allow people who historically couldn’t get into remission to have the option for another line of therapy.”

Of course, these new treatments do come with potential side effects, most of which are linked to their method of ‘supercharging’ the body’s T-cells.

CAR-T therapy can  have significant side effects, as it generates a huge cytokine storm in the blood, says Dr Bacon.

“But,” he added, “as we’re learning more about these new drugs and how best to use them, they are becoming much safer.”

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