Fit cells, fertile ground: Immunometabolic programming and bone marrow niche support in durable CAR T cell response in leukemia

CD19-targeted chimeric antigen receptor (CAR) T cell therapy has transformed the treatment landscape for relapsed/refractory (r/r) B cell acute lymphoblastic leukemia (B-ALL), offering patients with otherwise limited options a meaningful chance at remission. Despite impressive initial response rates, however, between 30% and 80% of patients ultimately experience CD19-positive relapses, underscoring a critical unmet need: understanding why some patients achieve durable remissions while others do not.