Examining the Current Role of CAR T-Cell Therapy in Acute Myeloid Leukemia

Jae H. Park, MD, attending physician, Leukemia Service and Cellular Therapeutics Center, Memorial Sloan Kettering Cancer Center, discusses the current role and challenges in using chimeric antigen receptor (CAR) T-cell therapy in patients with relapsed or refractory acute myeloid leukemia (AML). The 2 challenges now in this area are target selection and patient selection.

Targets available now for CD33 and CD123 have been good, but there are concerns for the long-term adverse effects that may arise, says Park, especially as these targets are also expressed in some endothelial cells and hematopoietic stem cells. CAR T-cell therapy is still considered as a bridge to transplant as a result, and many clinical trials often require at least an option for patients to proceed to transplant even after a response is seen. The targets may not be ideal for CAR T-cell therapy yet, he says, so bispecific therapy may be necessary.

Just like with acute lymphoblastic leukemia, AML is a rapidly progressing disease and patients are often refractory, so there is minimal time for patients to wait for the CAR T cells to be made. Park says in that time, patients need salvage therapy; however, there are not many salvage therapy options for these patients. This ultimately leads to losing more patients along the way.