Chimeric antigen receptor T cell therapy in childhood leukaemia

Chimeric antigen receptor (CAR) T cell therapy is a promising form of adoptive cell therapy. This process re-engineers patient-derived T cells to express a hybrid receptor targeting a selected tumour-expressed antigen. CAR T cell therapy directed against the CD19 antigen has been highly successful in haematological malignancies that have failed other therapies, particularly relapsed B-cell acute lymphoblastic leukaemia (B-ALL). This review focuses on the numerous real-world aspects of treating children with B-ALL with CD19-targeted CAR T cell therapy. We discuss some of the considerations for clinicians including manufacturing time, administration and care of the patient receiving this novel therapy, toxicities and outcomes. We also discuss the therapeutic uncertainty many physicians now face of when to use CAR T cell therapy in the patient journey, especially when haematopoietic stem cell transplant is being considered.