ReviewChimeric Antigen Receptor T Cells and Hematopoietic Cell Transplantation: How Not to Put the CART Before the Horse

- Chimeric antigen receptor T (CART) cell therapy is an effective and potentially curative form of immunotherapy.
- CART cells can induce remissions as a bridge to allogeneic hematopoietic cell transplantation (allo-HCT) in B cell malignancies.
- In some patients, CART cells can induce sustained remission and replace allo-HCT.
- For patients relapsing after allo-HCT, CART cell therapy is a very effective option.

Hematopoietic cell transplantation (HCT) remains an important and potentially curative option for most hematologic malignancies. As a form of immunotherapy, allogeneic HCT (allo-HCT) offers the potential for durable remissions but is limited by transplantation- related morbidity and mortality owing to organ toxicity, infection, and graft-versus-host disease. The recent positive outcomes of chimeric antigen receptor T (CART) cell therapy in B cell malignancies may herald a paradigm shift in the management of these disorders and perhaps other hematologic malignancies as well. Clinical trials are now needed to address the relative roles of CART cells and HCT in the context of transplantation-eligible patients. In this review, we summarize the state of the art of the development of CART cell therapy for leukemia, lymphoma, and myeloma and discuss our perspective of how CART cell therapy can be applied in the context of HCT.