CAR T-Cell Therapy for Patients with Lymphoma

An overview of the therapies available for patients with diffuse large B-cell lymphoma (DLBCL) and transformed follicular lymphoma.

Miguel-Angel Perales, MD, deputy chief, Adult Bone Marrow Transplant Service, director, Adult Bone Marrow Transplantation Fellowship Program, Memorial Sloan Kettering Cancer Center, discusses the use of CAR T-cell therapy in diffuse large B-cell lymphoma (DLBCL) and transformed follicular lymphoma.

PERALES: There are currently 2 approved CAR T-cell products: tisagenlecleucel (Kymriah) and axicabtagene ciloleucel (axi-cel; Yescarta), explains Perales. These products are primarily approved for patients with DLBCL in third-line therapy.

Now that the drugs have been approved for a short period of time, real-world data are starting to emerge and is showing similar results to what was seen in clinical trials, says Perales. However, according to Perales, about 43% of the patients being treated with CAR T-cell therapy in the real-world setting would not have qualified for the clinical trials. The indication for DLBCL or transformed follicular lymphoma is still followed, but some of the other parameters around patient eligibility, including comorbidity factors, are being ignored. Therefore, patients with low platelets and active deep vein thrombosis are now allowed to be treated with CAR T-cell therapy, states Perales.

The side-by-side comparison of the ZUMA-1 trial results with real-world experience shows similar safety and efficacy results. However, one limitation was the short follow-up at less than 4 months, which will hopefully be updated soon, concludes Perales.