Taking the Next Steps to Advance Supportive Care in Leukemia

At the 2025 National Immune Cell Effector Therapy (ICE-T) Conference, experts gathered to discuss all things related to cellular therapies. During the Supportive Care in Leukemia Session, the conversations centered on managing toxicities, particularly neurological events such as immune effector cell–associated neurotoxicity syndrome (ICANS).

CancerNetwork® spoke with Nausheen Ahmed, MD, associate professor, associate director for cellular therapeutics, and the medical director of the Cell Therapy Survivorship Program in the Division of Hematologic Malignancies and Cellular Therapeutics in the Department of Internal Medicine at the University of Kansas Cancer Center as well as course director for the ICE-T symposium, at the conference.

Ahmed discussed the variability in prophylactic levetiracetam (Keppra) use at different institutions, as some only use it in the event of ICANS. She iterated the need for more data on that subject.

There also needs to be improved access to newer therapies in acute lymphoblastic leukemia (ALL) treatment, according to Ahmed. Currently, there is access to chimeric antigen receptor (CAR) T-cell therapies that target CD19, but more agents that target CD20 and CD22 are needed.

Transcript:

The very interesting question that was brought up was about [levetiracetam] and whether we should use it or not. There’s heterogeneity in using prophylactic [levetiracetam]…to prevent seizures. There are some institutions that use it across the board from day 0 to day 30, and then there are some institutions that don’t. They will only initiate it if there is an event of ICANS. We walked through and talked about some of these aspects. We need a study or retrospective data to look at that, but right now, we don’t have any hard data to do the prophylaxis. However, we don’t have any data on what happens when we don’t use it.

There are a couple of [next steps]. With these therapies, especially with ALL, the issues that we’ve been facing with our previously available CAR [T-cell therapies] have been the toxicities, particularly the neurological toxicities and hematological toxicities. We navigated through some of those with the speakers. The other thing is access and the need for newer therapies. We have the current CAR [T-cell therapies], which target CD19; however, we need others. For example, [Sunil Abhyankar, MD,] brought up his triple-threat CAR [T-cell therapy], which targets CD19, CD20, and CD22. It’s in the context of a clinical trial, but we’re eager to look at the outcomes from that.