Immunotherapy: genetically agnostic in BCP-ALL?

In this issue of Blood, Leahy et al demonstrate that the current cytogenetic risk stratification of B-cell precursor acute lymphoblastic leukemia (BCP-ALL) is no longer predictive in patients receiving immunotherapy.(1) Primary response to chimeric antigen receptor (CAR) T-cell infusion (either tisagenlecleucel/ CTL019 or a humanized CD19 CAR T cell) and 2-year event-free and overall survival were comparable between the different cytogenetic risk categories. Disease response and relapse rates are comparable to data reported by Pasquini et al in a large cohort of patients receiving tisagenlecleucel outside clinical studies.2 Since the treatment of Emily Whitehead in 2010 with CTL019 for refractory BCP-ALL, CAR T-cell treatment has evolved, with Food and Drug Administration/European Medicines Agency approval obtained in 2017-2018. Of interest, other immunotherapy in BCP-ALL, like blinatumomab, has also reported to be genetic risk-group agnostic.3