Refining patient selection for CAR T-cell therapy in aggressive large B-cell lymphoma

Abstract

Relapsed or refractory non-Hodgkin B-cell lymphoma is an aggressive disease with a dismal prognosis. Chimeric antigen receptor (CAR) T-cell therapy has emerged as a viable treatment option with durable remissions observed in clinical trials. Due to the risk of toxicities such as cytokine release syndrome and neurotoxicity, careful patient selection is critical to optimize outcomes. Narrow selection criteria were used in clinical trials that led to approval, but a wider range of patients has been successfully treated in the commercial setting. Due to lack of validated pretreatment clinical factors, including risk scores or biomarkers to predict efficacy and toxicity, choosing candidates for CAR T-cell therapy currently relies on expert opinion. Because of logistical constraints and often aggressive disease, we favor referring patients early for cellular therapy at the time of first treatment failure. Herein, we discuss criteria for patient selection using a case-based approach informed by reports of real-world outcomes.

Keywords:

• Chimeric antigen receptor T-cells
• patient selection
• large B-cell lymphoma

Acknowledgements

The authors acknowledge Dr. Sonali Smith for her editorial assistance.

Disclosure statement

Peter Riedell has served on the advisory board for Kite/Gilead, Verastem, Celgene, and Bayer. He has received honoraria from Novartis and has served as a speaker and performed consulting for Bayer and Kite/Gilead. He receives institutional research funding from Celgene, Juno, Novartis, and Kite/Gilead. Kirk Cahill and Michael Leukam report no relevant conflicts of interest.

Data availability statement

Data sharing is not applicable to this article as no new data were created or analyzed in this study.