Expert Point of View: Prashant Kapoor, MD

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At the recent American Society of Hematology Annual Meeting, Prashant Kapoor, MD, Assistant Professor of Hematology at Mayo Clinic, Rochester, Minnesota, agreed that CTL019 is a promising, exciting, and novel approach to treating patients with advanced B-cell hematologic malignancies.

“Although still in the preliminary stages of development, and offered only by very few centers, the ability of CTL019 cells to achieve sustained remissions makes them particularly attractive for patients with refractory diseases. The central nervous system (CNS) can occasionally serve as a sanctuary site for leukemia cells. CTL019 cells appear to efficiently migrate to the CNS and could prevent CNS relapse,” Dr. Kapoor said.

Cytokine Release Syndrome

He noted that close monitoring is required after the single-infusion therapy because of the possibility of cytokine release syndrome reported in several of the small trials. In more recent trials, tocilizumab (an anti–interleukin-6 drug) has been effective.

Despite this potential side effect, he continued, “Immune therapies typically have a favorable long-term toxicity profile. Unfortunately, relapses with subclones that do not express CD19 (‘CD19 escape cells’) have been shown to occur, but could theoretically be circumvented by simultaneously targeting antigens other than CD19.”

Some of the current investigations are, in fact, targeting other antigens. ■

Disclosure: Dr. Kapoor reported no potential conflicts of interest.

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