{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,6]],"date-time":"2025-12-06T21:38:57Z","timestamp":1765057137859,"version":"3.46.0"},"reference-count":64,"publisher":"American Society of Hematology","issue":"1","content-domain":{"domain":["ashpublications.org"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2025,12,5]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Anti-CD19 chimeric antigen receptor (CAR) T cells can induce complete remission in the majority of children and young adults affected by multiple relapsed\/refractory B-cell precursor acute lymphoblastic leukemia (ALL) and provide potential long-term cure through continuous surveillance against leukemic recurrence. The presence of B-cell aplasia represents an indirect marker of CAR T functional persistence. Patients treated with tisagenlecleucel who present with early (within 6 months from infusion) B-cell recovery (BCR) have an increased risk of relapse and merit further treatment. In this work, we describe a pediatric clinical scenario and discuss the possible interventions\u2014that is, hematopoietic stem cell transplantation (HSCT), second CAR T infusion, and maintenance chemotherapy\u2014for similar patients with early BCR after CAR T, based on the available literature. We advocate for HSCT with total body irradiation (TBI) in children who had never received transplantation and can safely undergo TBI, while those who already had a first HSCT with TBI or present with a contraindication to TBI, in the absence of available clinical trials, can be considered for maintenance chemotherapy, given early indications of good tolerability and promising noninferior outcomes. Patients with Philadelphia-positive ALL should receive tyrosine kinase inhibitors in the context of either HSCT or maintenance chemotherapy. For young adults, 3 different commercial CAR T are available, but so far, clinical data are insufficient to support any specific consolidation strategy.<\/jats:p>","DOI":"10.1182\/hematology.2025000734","type":"journal-article","created":{"date-parts":[[2025,12,5]],"date-time":"2025-12-05T14:09:04Z","timestamp":1764943744000},"page":"432-442","update-policy":"https:\/\/doi.org\/10.1182\/blood.2019cm0000","source":"Crossref","is-referenced-by-count":0,"title":["Maintenance after CAR T? Are we there yet? Reducing the risk of relapse after loss of anti-CD19 CAR T\n                    <i>-<\/i>\n                    cell persistence in ALL"],"prefix":"10.1182","volume":"2025","author":[{"given":"Maria","family":"Gabelli","sequence":"first","affiliation":[{"name":"1 Pediatric Oncology, Hematology and Hematopoietic Stem Cell Transplantation, University Hospital of Padova, Padova, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sara","family":"Ghorashian","sequence":"additional","affiliation":[{"name":"2 Department of Haematology, Great Ormond Street Hospital for Children, London, United Kingdom"},{"name":"3 Developmental Biology and Cancer, UCL-Great Ormond Street Institute of Child Health, London, United Kingdom"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"234","published-online":{"date-parts":[[2025,12,5]]},"reference":[{"issue":"5","key":"2025120616340502500_hem2025000734C1","doi-asserted-by":"crossref","first-page":"439","DOI":"10.1056\/NEJMoa1709866","article-title":"Tisagenlecleucel in children and young adults with B-cell lymphoblastic leukemia","volume":"378","author":"Maude","year":"2018","journal-title":"N Engl J Med"},{"issue":"21","key":"2025120616340502500_hem2025000734C2","doi-asserted-by":"crossref","first-page":"5414","DOI":"10.1182\/bloodadvances.2020003092","article-title":"Real-world evidence of tisagenlecleucel for pediatric acute lymphoblastic leukemia and non-Hodgkin lymphoma","volume":"4","author":"Pasquini","year":"2020","journal-title":"Blood Adv"},{"issue":"9","key":"2025120616340502500_hem2025000734C3","doi-asserted-by":"crossref","first-page":"945","DOI":"10.1200\/JCO.20.03585","article-title":"Disease burden affects outcomes in pediatric and young adult B-cell lymphoblastic leukemia after commercial tisagenlecleucel: a pediatric real-world chimeric antigen receptor consortium report","volume":"40","author":"Schultz","year":"2022","journal-title":"J Clin Oncol"},{"issue":"10","key":"2025120616340502500_hem2025000734C4","doi-asserted-by":"crossref","first-page":"e766","DOI":"10.1016\/S2352-3026(22)00225-3","article-title":"Tisagenlecleucel therapy for relapsed or refractory B-cell acute lymphoblastic leukaemia in infants and children younger than 3 years of age at screening: an international, multicentre, retrospective cohort study","volume":"9","author":"Ghorashian","year":"2022","journal-title":"Lancet Haematol"},{"issue":"9","key":"2025120616340502500_hem2025000734C5","doi-asserted-by":"crossref","first-page":"1664","DOI":"10.1200\/JCO.22.00642","article-title":"Three-year update of tisagenlecleucel in pediatric and young adult patients with relapsed\/refractory acute lymphoblastic leukemia in the ELIANA 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