Clinical Practice Recommendations on the Role Of Allogeneic Hematopoietic Cell Transplantation and Chimeric Antigen Receptor T-Cell Therapy in Patients With Chronic Lymphocytic Leukemia on Behalf of the American Society for Transplantation and Cellul

Chimeric antigen receptor T-cell therapy (CAR T-cell) is a new treatment option for relapsed and/or refractory (R/R) chronic lymphocytic leukemia (CLL). Novel therapies including Bruton's tyrosine kinase inhibitors (BTK), covalent or noncovalent, and an inhibitor of the B-cell leukemia/lymphoma 2 protein (BCL-2), venetoclax, have replaced chemoimmunotherapy (CIT) regimens in the front-line and the R/R setting, and have relegated allogeneic hematopoietic cell transplantation (allo-HCT) to later treatment stages. Updating the 2016 clinical practice recommendations on allo-HCT in CLL is necessary to help guide contemporary clinical practice. A panel of 18 physicians with diverse expertise across different CLL treatment modalities and one methodologist participated in this effort. Any recommendation receiving ≥ 70% votes was considered a consensus. CAR T-cell therapy is recommended for patients not responding or relapsing after at least 2 lines of therapy consisting of a covalent BTK inhibitor and a BCL-2 inhibitor. In addition, CAR T-cell therapy is recommended for patients who subsequently received a noncovalent BTK inhibitor in the third-line or later setting, regardless of response. CAR T-cell therapy is also recommended in CLL relapsing after an allo-HCT, assuming that patients are fit for the procedure. In those CLL patients who are candidates, allo-HCT is recommended if disease is R/R to CAR T-cell therapy provided that an objective response is demonstrated prior to the allograft. Allo-HCT is also recommended in patients with clonally-related Richter transformation (RT) after demonstrating an objective response to front-line CIT or other treatments. CAR T-cell therapy is recommended in R/R RT. We emphasize the importance of enrolling patients in clinical trials whenever available to continue to advance the field and improve prognosis of R/R CLL. We acknowledge that there are unique clinical scenarios not covered herein which may require a case-by-case approach.

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Publication Details

Journal
Transplantation and Cellular Therapy
Published
2025-06-11
DOI
https://doi.org/10.1016/j.jtct.2025.06.002
Primary Topic
CAR-T cell therapy research
Type
article
Field-Weighted Citation Impact
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article

Clinical Practice Recommendations on the Role Of Allogeneic Hematopoietic Cell Transplantation and Chimeric Antigen Receptor T-Cell Therapy in Patients With Chronic Lymphocytic Leukemia on Behalf of the American Society for Transplantation and Cellul

Jeremy S. Abramson, Tanya Siddiqi, Mehdi Hamadani, Richard R. Furman et al.
Transplantation and Cellular Therapy
CAR-T cell therapy research
article

Clinical Practice Recommendations on the Role Of Allogeneic Hematopoietic Cell Transplantation and Chimeric Antigen Receptor T-Cell Therapy in Patients With Chronic Lymphocytic Leukemia on Behalf of the American Society for Transplantation and Cellul

Jeremy S. Abramson, Tanya Siddiqi, Mehdi Hamadani, Richard R. Furman, Jennifer Ann Woyach, Nakhle S. Saba, Jennifer R. Brown, Mohamed A. Kharfan‐Dabaja, Nitin Jain, Deborah Marie Stephens, Catherine C. Coombs, Amer Beitinjaneh, Danielle M. Brander, Taha Al‐Juhaishi, Mazyar Shadman, Saad S. Kenderian, Farrukh T. Awan, Nadia Khan, Ambuj Kumar, Jennifer Collins, Javier Pinilla‐Ibarz
article en

Abstract

Chimeric antigen receptor T-cell therapy (CAR T-cell) is a new treatment option for relapsed and/or refractory (R/R) chronic lymphocytic leukemia (CLL). Novel therapies including Bruton's tyrosine kinase inhibitors (BTK), covalent or noncovalent, and an inhibitor of the B-cell leukemia/lymphoma 2 protein (BCL-2), venetoclax, have replaced chemoimmunotherapy (CIT) regimens in the front-line and the R/R setting, and have relegated allogeneic hematopoietic cell transplantation (allo-HCT) to later treatment stages. Updating the 2016 clinical practice recommendations on allo-HCT in CLL is necessary to help guide contemporary clinical practice. A panel of 18 physicians with diverse expertise across different CLL treatment modalities and one methodologist participated in this effort. Any recommendation receiving ≥ 70% votes was considered a consensus. CAR T-cell therapy is recommended for patients not responding or relapsing after at least 2 lines of therapy consisting of a covalent BTK inhibitor and a BCL-2 inhibitor. In addition, CAR T-cell therapy is recommended for patients who subsequently received a noncovalent BTK inhibitor in the third-line or later setting, regardless of response. CAR T-cell therapy is also recommended in CLL relapsing after an allo-HCT, assuming that patients are fit for the procedure. In those CLL patients who are candidates, allo-HCT is recommended if disease is R/R to CAR T-cell therapy provided that an objective response is demonstrated prior to the allograft. Allo-HCT is also recommended in patients with clonally-related Richter transformation (RT) after demonstrating an objective response to front-line CIT or other treatments. CAR T-cell therapy is recommended in R/R RT. We emphasize the importance of enrolling patients in clinical trials whenever available to continue to advance the field and improve prognosis of R/R CLL. We acknowledge that there are unique clinical scenarios not covered herein which may require a case-by-case approach.

Transplantation and Cellular TherapyVol. 31(8)
University of North Carolina at Chapel Hill (US), Louisiana State University (US), City Of Hope National Medical Center (US), Mayo Clinic (US), NewYork–Presbyterian Hospital (US), The University of Texas MD Anderson Cancer Center (US), University of Miami (US), University of California, Irvine (US), Medical College of Wisconsin (US), Cornell University (US), University of South Florida (US), New York Hospital Queens (US), Moffitt Cancer Center (US), University of Chicago (US), Massachusetts General Hospital (US), Fred Hutch Cancer Center (US), Swedish Medical Center (US), Presbyterian Hospital (US), University of California, Irvine Medical Center (US), Dana-Farber Cancer Institute (US), Mayo Clinic in Arizona (US), Duke Medical Center (US), Mayo Clinic in Florida (US), Duke Cancer Institute, University of Oklahoma Health Sciences Center (US), The Ohio State University (US), Louisiana State University Health Sciences Center New Orleans (US), The University of Texas Southwestern Medical Center (US)
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Openalex Percentile: Top 80%
CAR-T cell therapy research
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