What is cellular therapy? Is this currently being used to treat acute myeloid leukemia?

What is cellular therapy?

Is this currently being used to treat AML?

So cellular
therapy has really revolutionized

the treatment of a lot of different
hematologic malignancies, such

as lymphoma, multiple myeloma as well.

But in AML
it has not been effective to date.

And a lot of this has to do with the fact

that cellular therapies
really need a target to go after.

You really need something for this
cellular therapy product

to target and clear away the disease
and in AML,

because these cells come
from a very early form of a stem

cell in the bone marrow,
it is very difficult to find targets

that can say this is a leukemia cell
and this is a normal cell.

And so there is advances
that are being made.

And to identify
these different targets of leukemia cells

that can be exploited to target with

different cellular therapy products.

But to date, it hasn't been as encouraging
as it has been in other diseases

where there are more established targets
to differentiate cancer versus non cancer.

Cellular therapy,
you know, is so in some ways, again,

the bone
marrow transplants, as I mentioned

before, is a form of cellular therapy.

And fundamentally, these are,
you know, bone marrow cells, stem cells

from a donor.

That are being used to, again,
to hopefully kill

off the bad leukemia cells
once they make a new immune system.

So that's that's really

in some ways, bone marrow transplantation
is a form of cellular therapy.

There are other forms of cellular therapy.

And, you know, I think, you know, people
often ask about things like CAR-T cells.

So CAR-T cells stands for chimeric
antigen receptor,

CAR, T cells are a type of immune cell.

So that is also a form of cellular therapy
and that's a form of cell therapy

that has been best studied and is approved
not in acute myeloid leukemia,

but in a different acute leukemia called
acute lymphoblastic Leukemia, or ALL.

Not in AML
but in ALL, and in those ALL patients,

you know, CAR-T cell
therapy has proven to be, you know,

remarkably effective in certain settings
and even in settings

where other therapies might not have been,
you know, effective.

And this there are some risks to that

you know as well,
which we could talk about.

But the key for
and one of the keys for an effective

CAR-T cell
therapy is having the right target.

So fundamentally
what CAR-T cell therapy is,

you know, ideally you take a patient's
cells, take them back to the laboratory,

and you actually genetically modify
those cells

so that they can see and attack
the patient's cancer cells.

But you have to basically build in
what is the target

that you want
these cells to find and kill off.

So in acute lymphoblastic leukemia,
it turns out that there is a cell surface

protein that's a really good target
for the for the CAR-T cells.

So CD19 is on the surface
of all these B cells.

And so it basically enables these immune
cells to recognize the 19 and attack

and kill off, you know, all of the cells
it finds that has that that protein.

So in ALL that works
really, really pretty well

and you can get rid of all of these,
you know, B cell like cells, for example.

And you can live without those cells.

You can get infusions of antibodies
as needed.

And that's kind of what those cells
would normally do in AML.

It's tougher
because AML, acute myeloid leukemia,

those cancer cells look a lot
like the other normal bone marrow cells.

They share a lot of the same cell
surface proteins.

So that can be very challenging
because when you design a therapy,

what's the target then?

So if you designed it against something
like CD34

or CD33, these are just proteins
on the surface of, of the cells.

You might,
you know, wipe out the bad leukemia,

but then you're also really maybe
wiping out

a lot of the good cells as well and maybe
having other sort of side effects.

So it's tough.

So CAR-T cell therapy right now.

And so as a form of cellular
therapy is very much investigational

in acute myeloid leukemia.

But there are some clinical trials
that are ongoing.

You know, here at Sloan Kettering,
we're about to roll out one of our

our first, you know, CAR-T-cell
trial for acute myeloid leukemia

to really excited about targeting a cell
surface protein called CLL-1

and then there's also some other
interleukin you know, some other ways

of basically modifying that cell
to make it really try to kill off the bad

leukemia cells.

But right now
it's at a very early stage, I would say.