Immune Therapies — The Future of Acute Lymphoblastic Leukemia Treatment

New targeted treatments might help patients avoid chemotherapy side effects

• CAR T-cell therapy re-engineers a patient’s immune cells to fight ALL
• Blinatumomab (brand name: Blincyto) pulls together the T cell and leukemia cell
• Inotuzumab (brand name: Besponsa) is a CD22-targeted monoclonal antibody that releases toxins once inside the tumor cell

We have entered a new era of acute lymphoblastic leukemia (ALL) therapy. Targeted treatments use the patients’ own immune system to attack the cancer, and in the process, possibly avoid some of the side effects of chemotherapy. Three therapies in particular are having a significant impact on the treatment of ALL patients who have relapsed.

One is CAR T-cell therapy, which re-engineers a patient’s immune cells to help them fight cancer. The beauty of this treatment is that it uses “something that is innate to the patient to target the leukemia,” Dr. Olalekan Oluwole, assistant professor of medicine in Hematology/Oncology at Vanderbilt University Medical Center, tells SurvivorNet Connect.

Blinatumomab (brand name: Blincyto) is another revolutionary ALL treatment known as a bispecific CD19-directed antibody therapy. It works by pulling the T cell and the leukemia cell together. “Many times the body knows that leukemia is there, but is unable to adequately engage it,” Dr. Oluwole says. “Blinatumomab kind of forces the T cell closer to the leukemia, and that then triggers the T cells to take out the leukemia.” It can help patients who have relapsed achieve the kind of deep remissions needed to get them a stem cell transplant.

Finally, there is inotuzumab (brand name: Besponsa), a monoclonal antibody targeting CD22. “Once it is internalized into the cell, it releases something that is poisonous and breaks that leukemia apart,” Dr. Oluwole says.

Because these drugs are more targeted, they may avoid some of the traditional side effects of chemotherapy. Targeted immune therapies have been found beneficial in the relapse setting. Now clinical trials are investigating whether introducing them earlier on might spare patients some chemotherapy, and its associated side effects. “That is going to be a big game changer,” Dr. Oluwole says.