How do you determine when to give a second CAR-T cell infusion to a pediatric or young adult patient with relapsed/refractory ALL?

Anti-CD19 CAR-T cell therapy has the capacity to induce high rates of clinical response in heavily pre-treated patients for CD19 expressing B-cell malignancies. Among those, B-cell ALL is a poster child for CAR T cell therapy given the propensity for inducing high rates of MRD-negative complete responses (CR) among responding patients across several trial cohorts. At the present time, Tisa-Cel (Kymriah) is the only CAR T product that is FDA approved in the management of relapsed/refractory pedia...

I would also add, in addition to @Dr. First Last's excellent response to this inquiry, that careful consideration should be given to the primary endpoint for considering a second CAR T-cell infusion.

If it is to allow for a subsequent remission followed by consolidation with an allogeneic stem cell transplant, one should carefully consider utilization of readily available alternative non-cellular immunotherapies such as Blinatumomab and Inotuzumab ozogamicin. Both have shown excellent results in...