Exploring CAR T Updates in Pediatric Acute Lymphoblastic Leukemia

In a cobranded episode between Oncology On the Go, hosted by CancerNetwork®, and the American Society for Transplantation and Cellular Therapy (ASTCT)’s program ASTCT Talks, an expert panel explored when early antibiotic de-escalation may be feasible for pediatric populations who undergo hematopoietic cell transplantation. The panel was hosted by Diego R. Hijano, MD, MSc, who was joined by his colleagues Gabriela Marón, MD, MSc, and Fareed Khawaja, MBBS.• The conversation examines antimicrobial stewardship and its role in microbial resistance prevention and microbiome health in a broad transplant population.• The panel explores when early antibiotic de-escalation may be safe and appropriate for patients undergoing hematopoietic cell transplantation in both adult and pediatrics.• Experts discuss emerging evidence and guidelines supporting shorter courses of gram-negative and gram-positive antibiotic coverage in transplant recipients.Marón began by contextualizing the traditional practice of continuing antibiotic therapy until neutrophil recovery, which was based on host defense physiology instead of clinical trial data. Prolonged antibiotic use, she said, may correspond with resistant pathogens, bloodstream infections, and increased intensive care unit mortality across pediatric populations. Additionally, a limited pipeline for new antibiotic agents, especially for pediatric patients, makes the prevention of resistance critical during patient care.Khawaja continued the discussion by highlighting recent literature and randomized clinical trials supporting the de-escalation of gram-negative coverage within 48 to 72 hours if no infection source is identified. He referenced new guidelines from the European Conference on Infections in Leukaemia, which support de-escalating antibiotics at 40 to 72 hours if no clear source of fever appears.1 Another study published in 2023 showed that decreased antibiotic days resulted in similar rates of successful treatment, subsequent fever, and 30-day mortality.2 Additionally, advances such as improved blood culture incubation and PET scans may bolster the ability of clinicians to safely de-escalate treatment.Future directions in the field, Khawaja said, may include investigating how aggressive stewardship impacts long-term outcomes while learning how to implement quality improvement programs. Marón also identified a need for more prospective pediatric trials and data on how the microbiome changes following prolonged antibiotic exposure.Hijano is medical director of Occupational Health and director of the Infectious Disease, Bone Marrow Transplant, and Cellular Therapy Division at St. Jude Children’s Research Hospital. Marón is a pediatric infectious disease specialist who works with patients who undergo transplant at St. Jude Children’s Research Hospital. Khawaja is an associate professor of Infectious Diseases, Infection Control and Employee Health, and Internal Medicine at The University of Texas MD Anderson Cancer Center.References1. Averbuch D, Vanbiervliet Y, Baccelli F, et al. Empirical and targeted antimicrobial therapy in patients with febrile neutropenia and haematological malignancy or after haematopoietic cell transplantation: recommendations from the 10th European Conference on Infections in Leukaemia. Lancet Infect Dis. 2026;26(6):e232-e247. doi: 10.1016/S1473-3099(25)00619-X.2. Patel PA, Teherani MF, Xiang Y, et al. Short-course empiric antibiotics in children undergoing allogeneic hematopoietic cell transplantation. Transplant Cell Ther. 2023;29(12):778.e1-778.e6. doi:10.1016/j.jtct.2023.09.011

In this episode of ASTCT Talks, host Terri Lynn Shigle, PharmD, BCOP, clinical pharmacy specialist with Stem Cell Transplantation and Cellular Therapy Department at The University of Texas MD Anderson Cancer Center and current ASTCT director of pharmacists (ex-officio), is joined by Erin Eberwein, PharmD, CPP, BCOP, clinical pharmacist practitioner for ambulatory setting with Stem Cell Transplant and Cellular Therapy at Duke University Hospital, and Cameron Ninos, PharmD, BCOP, cellular therapy clinical pharmacist at UW Health, to discuss the growing shift of CAR T therapy from the inpatient setting to outpatient.As advances in toxicity prediction, remote patient monitoring, and clinical guidance make outpatient cellular therapy increasingly feasible, centers are developing new models of care to safely administer CAR T therapy while improving patient access and experience. Drawing on their frontline experience, Drs. Eberwein and Ninos share practical approaches to building, managing, and optimizing outpatient CAR T programs.The discussion covers:Building and operating an outpatient CAR T clinic, including patient selection, multidisciplinary team structure, and after-hours support.Outpatient monitoring and management of cytokine release syndrome (CRS) and immune effector cell-associated neurotoxicity syndrome (ICANS), including remote monitoring technologies, caregiver education, and admission criteria.Key pharmacy considerations, including lymphodepletion dosing, supportive care strategies, growth factor use, and the expanding role of the clinical pharmacy specialist in outpatient cellular therapy.This episode provides practical insights for clinicians, pharmacists, and cellular therapy programs seeking to expand outpatient CAR T delivery while maintaining safety, coordination, and high-quality patient care.Listen to the episode below or on your favorite app. Subscribe to ASTCT Talks and share this episode with your colleagues to keep the conversation going. This episode was made possible through support from Johnson & Johnson.

In this episode of ASTCT Talks, host Daniel Olson, MD, medical oncologist and co-leader of the melanoma, sarcoma, and solid tumor cellular therapy programs at the University of Chicago, is joined by John Mullinax, MD, surgical oncologist at Moffitt Cancer Center, and Lauren Banks, MD, PhD, medical oncologist at Memorial Sloan Kettering Cancer Center, to discuss the emerging role of tumor-infiltrating lymphocyte (TIL) therapy in sarcoma.As TIL therapy expands beyond melanoma, investigators are exploring its potential in soft tissue sarcomas, including dedifferentiated liposarcoma and undifferentiated pleomorphic sarcoma. The conversation examines the scientific rationale for TIL therapy in sarcoma, early clinical results, and the unique surgical and operational considerations required to bring this cellular therapy approach to patients with solid tumors.The discussion covers:The unmet clinical need in sarcoma and why certain sarcoma subtypes may be particularly attractive candidates for TIL therapy.Early clinical experience with TIL therapy in sarcoma and what the initial results may mean for future treatment approaches.Practical considerations for tumor procurement, including lesion selection, surgical planning, and manufacturing success.The multidisciplinary collaboration required among surgery, medical oncology, pathology, radiology, and cellular therapy teams to successfully deliver TIL therapy.This episode provides clinical, translational, and operational perspectives on one of the most promising emerging applications of cellular therapy in solid tumors and explores what may be next for patients with sarcoma.Listen to the episode below or on your favorite app. Subscribe to ASTCT Talks and share this episode with your colleagues to keep the conversation going. This episode was made possible through support from Iovance.Disclaimer: The views and opinions expressed by the podcast participants are their own and do not necessarily reflect those of ASTCT. This episode is intended for educational purposes only and should not be construed as medical advice or treatment recommendations. Discussion of investigational therapies, clinical trial data, or emerging treatment approaches does not imply endorsement or establish a standard of care. Clinicians should consult current guidelines, prescribing information, and institutional protocols when making treatment decisions.

In this episode of ASTCT Talks, host Terri Lynn Shigle, PharmD, BCOP, clinical pharmacy specialist with Stem Cell Transplantation and Cellular Therapy Department at The University of Texas MD Anderson Cancer Center and current ASTCT director of pharmacists (ex-officio) and Mark Hamilton, MD, of The University of Texas MD Anderson Cancer Center discuss immune effector cell-associated enterocolitis (IEC-EC), a rare but potentially severe late complication of BCMA-directed CAR T-cell therapy. As the use of CAR T-cell therapies continues to expand, understanding and managing delayed toxicities has become increasingly important.The discussion highlights:The clinical presentation, incidence, and risk factors associated with IEC-EC.Current approaches to diagnosis, including endoscopy, pathology evaluation, and detection of CAR T-cell infiltration in the gastrointestinal tract.Emerging insights into the biology of IEC-EC and the role of persistent CAR T cells.Treatment strategies, supportive care considerations, and areas of ongoing research.This episode provides valuable clinical and translational perspectives on a rare but important CAR T-cell-related toxicity and explores how ongoing research may help improve diagnosis, management, and patient outcomes.Listen to the episode below or on your favorite app. Subscribe to ASTCT Talks and share this episode with your colleagues to keep the conversation going.This episode was made possible through support from Johnson & Johnson.

In a cobranded episode between Oncology On the Go, hosted by CancerNetwork®, and the American Society for Transplantation and Cellular Therapy’s (ASTCT) program ASTCT Talks, Terri Lynn Shigle, PharmD, BCOP hosted Vinita Pai, PharmD, MS, BCPPS, who spoke about the use of CAR T-cell therapy for pediatric patients, focusing on acute lymphoblastic leukemia (ALL).After a brief overview of progress in the cellular therapy field and pediatrics’ first and only FDA approved CAR T product since 2017, their discussion explored the following:Review of real-world practice and outcomes in ALLPediatric practical challenges including logistics, leukapheresis, and lymphodepletion chemotherapyStrategies for managing cell therapy toxicities in pediatricpatientsConsiderations for survivorship and long-term toxicitiesGaps in pediatric care and future directionsListen below or via your favorite podcast platform.ReferenceO'Leary MC, Lu X, Huang Y, et al. FDA approval summary: tisagenlecleucel for treatment of patients with relapsed or refractory B-cell precursor acute lymphoblastic leukemia. Clin Cancer Res. 2019;25(4):1142-1146. doi:10.1158/1078-0432.CCR-18-2035

In this episode of ASTCT Talks, Dr. Nirali Shah welcomes Crystal Mackall, MD, the Ernest and Amelia Gallo Family Professor at Stanford University and a pioneer in immuno-oncology and cellular therapy, for a conversation in the Titans of Transplant series.Dr. Mackall reflects on her journey into medicine, the mentors who shaped her career, and the evolution of immunotherapy from an emerging concept to a transformative treatment modality. She also shares her perspective on the future of cell and gene therapies, the challenges facing pediatric cancer drug development, and the importance of resilience, mentorship, and innovation in scientific careers.Tune in to hear about:Dr. Mackall's path to becoming a physician-scientist.Lessons learned from mentors and decades of leadership in the field.The evolution of immunotherapy and cellular therapy.Emerging opportunities in RNA-based therapeutics and next-generation treatments.Barriers to advancing pediatric cancer therapies.Advice for trainees and early-career investigators.The role of resilience, collaboration, and curiosity in a successful career.Listen to the episode below or on your favorite podcast app. Subscribe to ASTCT Talks to stay up to date on the latest conversations in transplantation and cellular therapy.

In this episode of ASTCT Talks, host Terri Lynn Shigle, PharmD, BCOP, Clinical Pharmacy Specialist in the Stem Cell Transplantation and Cellular Therapy Department at The University of Texas MD Anderson Cancer Center, sits down with Lauren Campasano, MSW, LCSW, OSW-C, a licensed clinical social worker in New Jersey at Robert Wood Johnson Barnabas Health, to discuss the vital role social workers play throughout the CAR T therapy journey.Together, they explore how social workers help patients and caregivers navigate the complex medical, emotional, financial, and logistical challenges associated with CAR T therapy. From pre-treatment evaluation through post-treatment recovery, the conversation highlights the importance of multidisciplinary support in improving the patient experience and optimizing outcomes.The discussion covers:The role of social workers in CAR T patient assessment, caregiver support, and treatment readiness.Common psychosocial, financial, and logistical barriers patients face during CAR T therapy.Best practices for integrating social work into the multidisciplinary cellular therapy team.This episode offers valuable insights for clinicians seeking to better understand the critical contributions of social work to CAR T care and patient-centered cellular therapy programs. Listen to the episode below or on your favorite app. Subscribe to ASTCT Talks and share this episode with your colleagues to keep the conversation going.This episode was made possible through support from Johnson & Johnson.

In this episode of ASTCT Talks, host Daniel Olson, MD, of the University of Chicago, is joined by Stephanie Goff, MD, of the National Cancer Institute (NCI), and Allison Betof, MD, PhD, of Stanford Medicine to discuss the evolution and expanding role of tumor-infiltrating lymphocyte (TIL) therapy in solid tumors. From its early development at the NCI to its recent FDA approval in melanoma, the conversation explores how TIL therapy is reshaping treatment options for patients with advanced solid tumors. The discussion highlights:The history and key milestones that led to the development and approval of TIL therapy. The role of TIL therapy in the current melanoma treatment landscape. Practical considerations for treatment delivery, including lymphodepleting chemotherapy and IL-2 administration.This episode provides valuable clinical and operational perspectives on one of the most promising cellular therapy approaches for solid tumors and what’s next for the field.Listen to the episode below or on your favorite app. Subscribe to ASTCT Talks and share this episode with your colleagues to keep the conversation going. This episode was made possible through support fromIovance.

In this episode of ASTCT Talks, Dr. Nirali Shah talks with Dr. Catherine Bollard as part of the Titans of Transplant series to explore her remarkable career journey and lasting impact on the field of transplantation and cellular therapy. From early inspirations rooted in personal experience to her leadership in advancing cell therapy, Dr. Bollard reflects on her decades of experience across research, clinical care, and mentorship. The conversation highlights both the scientific progress in cellular therapies and the human stories that continue to drive innovation. Dr. Bollard also shares insights into the challenges of building a career as a physician-scientist and the importance of passion, resilience, and collaboration in advancing the field.Tune in for a conversation that covers:Dr. Bollard's path into pediatric hematology/oncology and the personal experiences that shaped her focus on immunotherapy.Key milestones in the evolution of cell therapy, including early translational work and the path to broader adoption.Ongoing challenges in treating diseases like AML and pediatric solid tumors.The importance of mentorship, team science, and developing the next generation of leaders.Reflections on balancing a demanding career with her personal life and staying grounded in purpose.Listen to the episode below or on your favorite app. Subscribe to ASTCT Talks and share this episode with your colleagues to keep the conversation going.

In a cobranded episode between Oncology on the Go, hosted by CancerNetwork®, and the American Society for Transplantation and Cellular Therapy (ASTCT)’s program ASTCT Talks, Mitchell E. Horwitz, MD, highlighted key developments and ongoing initiatives related to allogeneic and cord blood transplantations among patients with different hematologic malignancies. The conversation touched upon the impact of omidubicel-onlv (Omisirge) on patient outcomes, current research on reducing the risk of graft-vs-host disease (GVHD) among transplantation recipients, and strategies for providing effective prophylaxis during treatment, among other topics.