[Choice of bridging therapy prior to reinjection of autologous CAR-T cells in patients aged 0-25 years treated for B-ALL (SFGM-TC)].

Abstract

CAR-T-cells represent a major change in the field of relapsed/refractory B-cell acute lymphoblastic leukemia treatment in children, adolescents and young adults. However, despite a high early response rate of more than 90%, almost half of patients relapse after CAR-T-cells treatment. Several clinical and biological factors predicting success and failure of CAR-T-cells have been identified thanks to real life studies. Bridging period between leukapheresis and CAR-T-cells reinfusion is considered as a key stone to allow CAR-T-cells procedure in optimal condition. No prospective study and few retrospective studies are available describing this period. Consequently, there is currently no available guidelines. This article aims to describe the objectives and risks of the bridge, and to define recommendations of treatment in each situation of relapsed or refractory B-ALL, Ph+/ABL-like B-ALL and in case of CNS disease or non-CNS extra medullary disease, precising the specific place of immunotherapy.