Integrating CAR-T cell therapy into the management of DLBCL: what we are learning

ABSTRACT

Introduction

Chimeric Antigen Receptor ;(CAR) T cells therapies have become part of the standard of care for patients with relapsed/refractory (R/R) diffuse large B-cell lymphoma (DLBCL). The weakness of CAR-T therapies is that there are no comparative clinical trials, although many publications based on real-life data have confirmed the results obtained in pivotal studies. After several years of the commercialization of CAR-T, some points still need to be fully clarified. Healthcare professionals have questions about identifying patients who may benefit from therapy. There are aspects inherent in the accessibility of care related to improved relationships between CAR-T-delivering and referral centers.

Areas covered

Open questions are inherent in the salvage and bridge therapy, predictive criteria for response and persistence of CAR-T after infusion. Managing toxicities remain a top priority and one of the points on which further knowledge is needed.

Expert opinion

This review aims to describe the current landscape of CAR-T cells in DLBCL, outline their outcomes and toxicities, and explain the outstanding questions that remain to be addressed.

KEYWORDS:

• CAR-T
• diffuse large B-cell lymphoma
• cells therapies
• ICANS
• CRS
• bridging therapy

Article highlights

• Anti-CD19 CAR-T cell therapy shows high rates a long term high rates of durable remissions in patients with DLBCL.

• Current guidelines indicate that CAR-T therapy is the standard of care in patients with refractory disease, early relapse after first-line chemotherapy, and in third-line.

• Frontline CAR-T cell therapy should be explored in patients with aggressive double/triple hit lymphoma.

• Open questions are inherent in the salvage and bridge therapy, predictive criteria for response and persistence of CAR-T after infusion.

• Managing short and long terms toxicities remain top of mind and one of the points on which further knowledge is needed.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.”

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

The authors are grateful to the Italian Association against Leukemia-Lymphoma-Myeloma (AIL), Reggio Calabria - Vibo Valentia, Section “Alberto Neri”, for financial support.