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.
Muffly et al. (Tue,) studied this question.