Consensus recommendations for CAR T-cell administration in adult acute lymphoblastic leukemia: a modified Delphi study
Abstract
Abstract The use of chimeric antigen receptor (CAR) T-cell therapy is increasing for adult B-cell acute lymphoblastic leukemia (B-ALL), with 3 CD19 CAR T-cell products commercially available. Several key clinical questions related to best practices for CAR T-cell administration in this population exist, and limited prospective randomized trials have been conducted to fill these knowledge gaps. Thus, to help guide clinical practice, we conducted a modified Delphi study to develop and validate consensus recommendations on the administration of commercially available CAR T-cell therapy for adults with B-ALL. Consensus panelists (n = 9) included principal investigators (PIs) from Real World Outcomes Collaborative of CAR T-Cell Therapy in Adult ALL (ROCCA) consortium sites and were selected based on expertise and CAR T-cell center volume. Final panel consensus recommendations were distributed for rating by the remaining PIs from ROCCA consortium sites, which served as the validation group (n = 27). Consensus topics included patient selection, bridging and pre–CAR T-cell leukemia staging, lymphodepletion, and CAR T-cell treatment setting, specific toxicity prevention and management, post–CAR T-cell response assessment and disease monitoring, and the role of consolidation and/or maintenance therapies after CAR T-cell therapy. Initially, 58 recommendation statements were evaluated for consensus. After 2 panel meetings, a total of 34 statements achieved consensus rating among the expert panel. After rating by the validation group, all but 1 recommendation statement continued to meet consensus, for a total of 33 consensus recommendation statements on the administration of CAR T-cell therapy in adult B-ALL.
Article Details
Authors (36)
Lori Muffly
1Division of Blood and Marrow Transplantation & Cellular Therapy, Stanford University, Stanford, CA
Noelle V. Frey
Cell Therapy and Transplant Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia
Gregory W. Roloff
3Section of Hematology/Oncology, University of Chicago, Chicago, IL
Jae A. Park
4Division of Hematology Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
Bhagirathbhai Dholaria
Anjali Advani
6Cleveland Clinic Taussig Cancer Institute, Cleveland, OH
Veronika Bachanova
Ryan D. Cassaday
8Division of Hematology and Oncology, University of Washington, Seattle, WA
Michael Daunov
9University Hospitals Cleveland Medical Center and Case Western Reserve University, Cleveland, OH
Kaitlyn C. Dykes
10Division of Blood and Marrow Transplantation, University of California, San Diego, La Jolla, CA
Vivian Irizarry Gatell
11Department of Medicine, University of Texas Southwestern, Dallas, TX
Michael R. Grunwald
12Levine Cancer Institute, Atrium Health, Charlotte, NC
Talal Hilal
13Mayo Clinic, Phoenix, AZ
LaQuisa C. Hill
14Baylor College of Medicine, Houston, TX
Omer Jamy
15Division of Hematology and Oncology, The University of Alabama at Birmingham, Birmingham, AL
Vamsi K. Kota
16Georgia Cancer Center at Augusta University, Augusta, GA
Muthu Veera Kumaran
17University of Arkansas Medical Center, Little Rock, AR
Chenyu Lin
Department of Earth and Planetary Sciences, Harvard University
Aaron C. Logan
19Department of Medicine, University of California San Francisco, San Francisco, CA
Marlise R. Luskin
20Dana-Farber Cancer Institute, Boston, MA
Kristen M. O'Dwyer
21University of Rochester Medical Center, Rochester, NY
Caspian Oliai
Olalekan O. Oluwole
Joshua P. Sasine
24Cedars-Sinai Medical Center, Los Angeles, CA
Marc S. Schwartz
25Division of Hematology and Oncology, University of Colorado Anschutz Medical Campus, Aurora, CO
Melhem M. Solh
26The Blood and Marrow Transplant Program at Northside Hospital, Atlanta, GA
Wendy Stock
Stephanie B. Tsai
27Loyola University Medical Center, Maywood, IL
Matthew Ulrickson
28Banner MD Anderson Cancer Center, Gilbert, AZ
Sumithira Vasu
29Department of Internal Medicine, The Ohio State University, Columbus, OH
Eunice S. Wang
30Roswell Park Cancer Institute, Buffalo, NY
Fevzi Firat Yalniz
31Division of Hematology and Blood and Marrow Transplantation, University of Kentucky, Lexington, KY
Stephen A. Strickland
32Sarah Cannon Transplant and Cellular Therapy Network, Nashville, TN
Jessica T. Leonard
33Division of Hematology Oncology, Oregon Health & Science University, Portland, OR
Bijal D. Shah
34Department of Malignant Hematology, Moffitt Cancer Center, Tampa, FL
Ibrahim Aldoss