CAR-T therapy in acute lymphoblastic leukemia (ALL): current clinical applications and beyond

Chimeric antigen receptor T-cell (CAR-T) therapy has revolutionized the treatment landscape for acute lymphoblastic leukemia (ALL), particularly in relapsed and refractory (r/r) B-cell ALL. This review explores the efficacy of this therapy targeting CD19 and CD22, addressing the challenges of antigen escape, treatment durability, and manufacturing delays. Innovative strategies, including bispecific CAR-T and FasT CAR-T technology, promise to overcome these limitations by improving production timelines and reducing relapse rates. The review further highlights the potential of combining CAR-T therapy with radiation or sequential targeting to enhance long-term outcomes in high-risk patients. Although CAR-T therapy has demonstrated significant clinical success, ongoing research is essential to improve persistence, reduce toxicity, and expand its applicability across broader patient populations.