Do CAR-T and Allogeneic Stem Cell Transplant Both Have a Place in Lymphoid Neoplasms?

Abstract

Allogeneic stem cell transplantation (allo-SCT) represented the first immunotherapy to treat hematologic malignancies: it has been considered as a cure for the disease and never as an approach to extend the life of patients. The success of allo-SCT derives both from the ability to treat patients with intensive chemoradiotherapy and from the potent graft-versus-leukemia effects mediated by donor immunity. Although considerable progress has been made in the last years, significant barriers still remain in the form of disease relapse, graft-versus-host disease, infectious complications, and regimen-related toxicities. Moreover, the treatment of hematologic malignancies, particularly acute lymphoblastic leukemia and certain forms of lymphomas, has been revolutionized by the commercial introduction of genetically modified autologous T-lymphocyte therapy (CAR-T). Our review discusses current standards and the shifting paradigms in the indications for allo-SCT and the role of CAR-T cell therapy for lymphoid neoplasms.

Effectiveness of CAR-T treatment toward the potential risk of second malignancies

“…Chimeric antigen receptor-modified T-cell (CAR-T) is a clinical and technological revolution ( 1 , 2 ). The more advanced developments that led to the commercialization of the first products, have identified as a target the molecule CD19, expressed in all leukemia acute lymphoblastic leukemia (ALL) ( 3 ) and in Non-Hodgkin Lymphoma (NHL) ( 4 ), such as diffuse (D) large B-cell lymphoma (LBCL) ( 5 ), follicular lymphoma (FL) ( 6 ), mantle-cel lymphoma (MCL) ( 7 ) and the molecule B-cell maturation antigen (BCMA), expresses in multiple myeloma (MM) ( 8 , 9 ). This approach has opened a new page in medicine because we have moved from the drug, understood as an active ingredient packaged and ready to be taken, to a highly personalized therapy.…”