A team of leading CAR-T specialists has published 33 consensus recommendations in the journal Blood to help clinicians navigate the use of CAR-T cell therapy in adult patients with acute lymphoblastic leukemia (ALL). Developed by the ROCCA consortium using a modified Delphi approach — which blends expert opinion with published evidence — the guidelines address critical gaps where prospective clinical trial data are still lacking.

The recommendations span the full treatment journey, from selecting the right patients and CAR-T products to managing toxicity and monitoring for disease recurrence. Notably, the panel recommends that all adults with relapsed/refractory B-ALL be referred for CAR-T regardless of age, prior therapy, or disease burden. Product selection, however, is age-dependent: patients under 18 should receive tisagenlecleucel, while those 26 and older should receive brexu-cel or obe-cel.

Key Takeaways:

• Bridging therapy is recommended when bone marrow disease burden is ≥5% or extramedullary disease is present before apheresis
• All patients should be restaged before lymphodepletion, regardless of bridging therapy use
• Post-treatment MRD monitoring should continue every 1–3 months for the first year, then at reduced intervals for 4 more years
• Conventional chemotherapy maintenance is not recommended; consolidation should be individualized

Why it matters: With CAR-T therapy rapidly becoming a standard option for adult ALL, these consensus guidelines give clinicians a much-needed, evidence-informed framework to standardize care and improve outcomes in a complex, high-stakes treatment setting.