Immunotherapy in Acute Lymphoblastic Leukemia: Standard Treatment
By Theertha Prasath
This article explores how different methods of immunotherapy can help treat B-cell acute lymphoblastic leukemia, highlighting the various positive and negative aspects of each, as well as a look into the future.
B-cell acute lymphoblastic Leukemia (B-ALL) is a blood cancer affecting the bone marrow, where white blood cells called lymphoblasts rapidly multiply, spreading throughout the body. More frequent in children, this disease’s most common treatment is chemotherapy, which is essentially the use of drugs to treat cancer. However, immunotherapy, a method involving influencing a patient’s own immune system to destroy cancerous cells, can also be an incredibly effective treatment. Currently, the two main types of immunotherapy that can treat children with B-ALL are bispecific T-cell engagers (BiTEs) and chimeric antigen receptor (CAR) T-cell therapy. Both methods have various benefits and drawbacks.
Bispecific T-cell Engager (BiTE)
For B-ALL, Blinatumomab, a monoclonal antibody drug, simultaneously links to two proteins: the CD19 protein—which consists of certain leukemia or lymphoma cells—and the CD3 protein, which is located on T cells, a type of immune cell. Through this process, the leukemia and immune cells are brought together, making it easier for the immune system to fight the leukemia cells.
Blinatumomab is typically injected into the vein through an IV for over 28 days continuously, sometimes repeated in cycles with two week gaps. However, there are various side effects that could be caused by this drug, including fevers, tremors, low potassium levels, or even nervous system problems (seizures, slurred speech, etc).
Chimeric Antigen Receptors (CAR) T-cell Therapy
For children, especially those who came back or weren’t responding to other medications, typically the drug used for CAR T-cell therapy is Kymriah. In this process, T-cells extracted from the patient’s blood in a process known as leukapheresis are manipulated to have these receptors, enabling them to attach onto cancerous cells. After being multiplied, these cells are then inserted back into the patient’s blood to attack the leukemia cells.
CAR T-cell therapy is usually injected into the patient’s vein through an IV after a few days of chemotherapy to prep. The removal of the T-cells usually takes a few hours, while the alteration of the cells could take weeks. But the side effects could be tragically fatal, ranging from the deadly cytokine release syndrome, which ramps up the immune system, to various types of serious infections or even other blood cancers.
The Future of Immunotherapy in B-ALL
Both treatments, although having serious side effects, became incredibly effective in decreasing death rates and increasing chances of survival. According to the New England Journal of Medicine, when taken with chemotherapy the BiTE treatment increased patients’ three-year survival rate from 88 to 96 percent. Additionally, CAR T-cell therapy increased recovery rates up to 94 percent. Both methods are being investigated for other types of blood cancers. Overall, immunotherapy has and will inevitably continue to make significant impacts on the lives of pediatric cancer patients.
Works Cited
The American Cancer Society medical and editorial content team. “Immunotherapy for Acute Lymphocytic Leukemia (ALL).” American Cancer Society, 11 November 2024, https://www.cancer.org/cancer/types/acute-lymphocytic-leukemia/treating/monoclonal-antibodies.html. Accessed 27 June 2025.
Ingeno, Lauren. “‘Breakthrough’ Phase 3 Study Changes Standard of Care for Childhood B-cell Leukemia.” Children's Hospital of Philadelphia Research Institution, 6 January 2025, https://www.research.chop.edu/cornerstone-blog/breakthrough-phase-3-study-changes-standard-of-care-for-childhood-b-cell-leukemia. Accessed 23 June 2025.
Wolpert, Jessica. “BiTE vs. CAR-T Cell Therapy: A Leukemia Treatment Comparison.” MyLeukemiaTeam, 2021, https://www.myleukemiateam.com/resources/leukemia-treatment-comparison. Accessed 30 June 2025.