[To transplant or not to transplant after CAR-T: that is the question!]

CAR-T cell therapy revolutioned the therapeutic landscape of the relapsed/refractory B-cell acute lymphoblastic leukemia (ALL-R/R), improving relapse-free survival and overall survival of patients. Optimal management of late complications, such as hematological toxicity as well as allogeneic transplantation role in the therapeutic sequence, are specific topics currently being debated. We report a case of a young woman with ALL-B R/R extramedullary relapsed after a first allogeneic transplant and second-line immunotherapy, successfully treated with brexu-cel obtaining a complete remission status confirmed after one year. We adopted a conservative strategy choosing to delay the option of a second allogeneic transplantation to manage a prologed severe hematological toxicity and to consolidate the remission obtained.