Unlike stem cell transplant, which has strict eligibility criteria, the majority of patients with blood cancer may be able to receive CAR-T cell therapy, regardless of other comorbidities, explained an expert.
When the first CAR-T cell therapy was approved for diffuse large B-cell lymphoma, clinicians thought that the eligibility criteria would be similar to stem cell transplantation. There was an assumption that the treatment might be best for younger, more healthy patients, according to Dr. Lori A. Leslie, director of the Indolent Lymphoma and CLL Research Program at John Theurer Cancer Center in Hackensack, New Jersey.
However, that turned out not to be the case, with no upper age limits on many clinical studies for CAR-T cell therapy.
“You can have all types of comorbidities, (and) as long as they’re controlled, we’re able to take patients through CAR-T safety now,” Leslie said in an interview with CURE®. “So I think that it really is an opportunity for the majority of patients, and is worth an evaluation at a CAR-T center. … Because I find a lot of times, patients and providers are pleasantly surprised at the type of patient (who) may benefit and be a candidate for CAR-T.”
So CAR-T cell therapy was first approved in diffuse large B cell lymphoma in (2018). And when it was first approved, we thought of this cell therapy similarly, as we thought of a stem cell transplant, either from someone's own body (autologous) or someone else's (allogeneic), in which patients had to be relatively young, you know, under 65, typically had good organ function: heart works, well, kidneys work well (the patient) has to be in good shape.
The more we've understood CAR-T (cell therapy) and how to treat side effects early and actually prevent some of the toxicities, the potential patients (who) are eligible have become much more broadly. So certainly, we do CAR-T in patients of any age. No, there's really no upper age limit on the clinical studies, which is quite different than how we used to think about transplant, for example.
(Regarding) organ function, patients have to be well-controlled, but you can have heart disease, you can have kidney disease (and be) on dialysis. You can have all sorts of comorbidities. As long as they're controlled, we're able to take those patients through CAR-T cell (therapy) safely now.
So I think that it really is an opportunity for the majority of patients, and is worth an evaluation at a CAR-T center. … Because I find a lot of times, patients and providers are pleasantly surprised at the type of patient (who) may benefit and be a candidate for CAR-T.
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