What would be your next line of therapy for a pediatric patient with T-ALL in first relapse who has not received a transplant?

These patients can be challenging to bring into remission, and a multi-agent salvage regimen should be considered. If the patient has not previously received nelarabine, it should be incorporated; re-treatment may also be considered in select cases. During the first cycle, dasatinib may be added in non-ETP disease, while venetoclax can be considered in ETP-ALL. Early consultation with the cellular therapy team is recommended to evaluate candidacy for CD7 CAR T-cell therapy as a bridge to transplant.