Opportunities and Challenges With CAR T-cell Treatment of Children and Young Adults With B-Cell Acute Lymphoblastic Leukemia: Review and Recommendations From the Westhafen Intercontinental Group

Chimeric antigen-receptor T-cells (CAR T-cells) targeted at pediatric B-cell precursor acute lymphoblastic leukemia (B-ALL) have changed the paradigm for treatment of relapsed and refractory B-ALL. We present a comprehensive review and recommendations approaching this topic from the Westhafen Intercontinental Group, which is comprised of leaders from the International Berlin Frankfurt, Muenster (iBFM) Stem Cell Transplantation Committee, the Center for International Blood and Marrow Transplant Research (CIBMTR) Pediatric Cancer Working Committee, the Children's Oncology Group (COG) Cellular Therapy Committee, the Pediatric Diseases Working Party (PDWP) of the European Society for Bone and Marrow Transplantation (EBMT) and the Pediatric Transplantation and Cellular Therapy Consortium (PTCTC). In this paper we examine the current state of CAR T-cell therapy in pediatric B-ALL, assess current and emerging integration of CAR T-cells into treatment algorithms, and discuss emerging strategies to overcome existing challenges.