title: Future directions in chimeric antigen receptor T cell therapy.
abstract: The impact of immunotherapy has grown exponentially in the past 5 years. Principle illustrations are encouraging results with engineered T cells expressing a chimeric antigen receptor (CAR). This experimental therapy is developing simultaneously in pediatric and adult clinical trials, making this field particularly relevant and exciting for pediatric oncologists.
  
  
  
  CAR-modified T cells targeting CD19 have produced dramatic antitumor responses in patients with relapsed/refractory B cell acute lymphoblastic leukemia. Clinical trials from several institutions, in both children and adults, using distinct CAR T cell products have demonstrated similar high complete remission rates of 61-93%, with durable remissions observed. Although the development of CARs for other malignancies has lagged behind, research into novel approaches to overcome inherent challenges is promising.
  
  
  
  Clinical trials of CAR-modified T cells have produced unprecedented results and are anticipated to have a broader impact as this approach expands into other indications, including other cancers and frontline therapy. The potential for long-term disease control, if fully realized, will have a transformative impact on the field.
authors.affiliation: aDivision of Oncology, Cancer Immunotherapy Program, The Children's Hospital of Philadelphia bDepartment of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
authors.forename: Shannon L
authors.initials: SL
authors.lastname: Maude
mesh_terms: D018941:Antigens, CD19 / Q000276:immunology*; D014408:Biomarkers, Tumor / Q000276:immunology*; D060846:Cell Engineering; D064987:Cell- and Tissue-Based Therapy / Q000379:methods*; D006801:Humans; D007167:Immunotherapy / Q000379:methods*; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000276:immunology / Q000628:therapy*; D011948:Receptors, Antigen, T-Cell / Q000627:therapeutic use*; D013601:T-Lymphocytes / Q000276:immunology*
chemical_list: D018941:Antigens, CD19; D014408:Biomarkers, Tumor; D011948:Receptors, Antigen, T-Cell