Consensus Recommendations for CAR T-Cell Administration in Adult Acute Lymphoblastic Leukemia: a Modified Delphi Study

The use of chimeric antigen receptor (CAR) T cell therapy is increasing in adult B-cell acute lymphoblastic leukemia (B-ALL), with three commercially available CD19 CAR T cell products. 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 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 leukemia staging, lymphodepletion and CAR T treatment setting, specific toxicity prevention and management, post-CAR T response assessment and disease monitoring, and the role of consolidation and/or maintenance therapies following CAR T cell therapy. Initially, 58 recommendation statements were evaluated for consensus. After two panel meetings, a total of 34 statements achieved consensus rating among the expert panel. After rating by the validation group, all but one 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.

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Publication Details

Journal
Blood
Published
2026-05-19
DOI
https://doi.org/10.1182/blood.2026033559
Primary Topic
Delphi Technique in Research
Type
article
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article

Consensus Recommendations for CAR T-Cell Administration in Adult Acute Lymphoblastic Leukemia: a Modified Delphi Study

Joshua Sasine, Fevzi Yalniz, Vivian Irizarry Gatell, Olalekan O. Oluwole et al.
Blood
Delphi Technique in Research
article

Consensus Recommendations for CAR T-Cell Administration in Adult Acute Lymphoblastic Leukemia: a Modified Delphi Study

Joshua Sasine, Fevzi Yalniz, Vivian Irizarry Gatell, Olalekan O. Oluwole, Gregory W. Roloff, Veronika Bachanová, Talal Hilal, Ryan D. Cassaday, Kaitlyn C. Dykes, Anjali S. Advani, Noelle V. Frey, Michael Daunov, Vamsi Kota, Jessica T. Leonard, Marc S. Schwartz, Ibrahim Aldoss, Stephen A. Strickland, Melhem M. Solh, Stephanie B. Tsai, Matthew L. Ulrickson, Lori Muffly, Michael R Grunwald, Bhagirathbhai Dholaria, Kristen M O'Dwyer, Chenyu Lin, Bijal D Shah, Jae H Park, Muthu Kumaran, Wendy Stock, LaQuisa C Hill, Sumithira Vasu, Omer Jamy, Caspian Oliai, Aaron C Logan, Marlise R. Luskin, Eunice S. Wang
article en

Abstract

The use of chimeric antigen receptor (CAR) T cell therapy is increasing in adult B-cell acute lymphoblastic leukemia (B-ALL), with three commercially available CD19 CAR T cell products. 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 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 leukemia staging, lymphodepletion and CAR T treatment setting, specific toxicity prevention and management, post-CAR T response assessment and disease monitoring, and the role of consolidation and/or maintenance therapies following CAR T cell therapy. Initially, 58 recommendation statements were evaluated for consensus. After two panel meetings, a total of 34 statements achieved consensus rating among the expert panel. After rating by the validation group, all but one 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.

Blood
Northside Hospital (US), Cedars-Sinai Medical Center (US), Roswell Park Comprehensive Cancer Center (US), City Of Hope National Medical Center (US), Loyola University Medical Center (US), Cleveland Clinic (US), Memorial Sloan Kettering Cancer Center (US), University of Kentucky (US), University of California, Los Angeles (US), Oregon Health & Science University (US), Duke University (US), University of California, San Francisco (US), Baylor College of Medicine (US), University of Washington (US), University Hospitals of Cleveland (US), University of Arkansas Medical Center (US), Hospital of the University of Pennsylvania (US), University of Minnesota System (US), Moffitt Cancer Center (US), University of Alabama at Birmingham (US), University of California San Diego (US), University of Chicago (US), Augusta University Health (US), Centennial Medical Center (US), Southwestern Medical Center (US), Levine Cancer Institute (US), Children’s Hospital at TriStar Centennial (US), Dana-Farber Cancer Institute (US), Mayo Clinic Hospital (US), Banner MD Anderson Cancer Center, University of Colorado Anschutz Medical Campus (US), The Ohio State University (US), University of Rochester (US), The University of Texas Southwestern Medical Center (US), Vanderbilt University Medical Center (US), Stanford University (US)
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Delphi Technique in Research
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