EBMT 2019
Insights and lessons from trials and clinical experience for CAR-T in relapsed/refractory diffuse large B-cell lymphoma

Although it is a relatively new therapy area, both clinical trial and real-world data are teaching us valuable lessons to take forward in the use of Chimeric Antigen Receptor (CAR) T-cell therapy for the treatment of relapsed/refractory (R/R) diffuse large B-cell lymphoma (DLBCL) and primary mediastinal large B-cell lymphoma (PMBCL) after ≥ two lines of systemic therapy.

We spoke to the experts who presented at the Kite Industry Symposium ‘CAR T cells: Understanding the past, improving the future’ and the Kite Industry Theatre Session ‘CAR T technology: From discovery to delivery’ at the European Society for Blood and Marrow Transplantation 2019 Annual Meeting, held in Frankfurt, Germany, March 2019. These sessions included discussion on licensed products, and were organized and fully funded by Kite, a Gilead Company.

Clinical evidence for axicabtagene ciloleucel from the ZUMA-1 trial and real-world settings

Frederick Locke, MD, from the Moffitt Cancer Center, Tampa, FL, discusses the pivotal Phase 1/2 results of ZUMA-1, the longer-term follow up of these patients (median 27.1 months) and how these trial results translate into routine clinical practice.

Immunosuppressive use and axicabtagene ciloleucel persistence

Drawing on learnings to date, Dr Locke discusses the use of immunosuppressive agents for axicabtagene ciloleucel therapy-related toxicities. Dr Locke also explains the expansion and persistence of CAR T-cells over time in lymphoma.

The impact of axicabtagene ciloleucel on the DLBCL treatment paradigm and patient outcomes

Historically, the prognosis of relapsed or refractory (R/R) diffuse large B-cell lymphoma (DLBCL) patients was poor, as discussed here by Norbert Schmitz, MD, PhD, of University Hospital Münster, Münster, Germany. Prof. Schmitz gives his perspective on the current and future impact of CAR T-cells on outcomes in this space.

Perspective on the unmet needs in R/R DLBCL and the future of CAR T-cell therapy

Prof. Schmitz offers his insight into the challenges of the current treatment paradigm for R/R DLBCL and highlights key questions for the future of treatment, including his perspective on CAR T-cell therapy.

CAR T-cell therapy in hematological oncology: current impacts and future frontiers

Reuben Benjamin, MBBS, FRCPath, PhD, of King’s College Hospital NHS Foundation Trust, London, UK, discusses the historical survival rates for relapsed high-grade B-cell lymphomas. Dr Benjamin highlights the impact that CAR T-cell therapy has had upon outcomes in this group, and touches upon further areas for improvement.

Future frontiers for CAR T-cell therapy

Dr Benjamin discusses the future of CAR T-cell therapy and what improvements are on the horizon. He covers improved understanding of resistance mechanisms and the development of allogeneic, or ‘off-the-shelf’, CAR-T products.

Selecting patients for axicabtagene ciloleucel: screening process, criteria and future frontiers

There exists an extensive screening process to select patients for axicabtagene ciloleucel treatment. Here, Dr Benjamin gives his insight into the key factors for assessment, and highlights both subjective and objective selection criteria.

Selecting the right patient for axicabtagene ciloleucel therapy

Catherine Thieblemont, MD, PhD, of Saint-Louis Hospital, Paris, France, explains the process that her center follows when determining if axicabtagene ciloleucel would be a suitable treatment for a patient with R/R DLBCL or PMBCL, highlighting the key factors to consider.

The team behind CAR T-cell therapy delivery

The success of CAR T-cell therapy is reliant upon the effective collaboration of healthcare professionals across multiple disciplines, as highlighted here by Catherine Thieblemont, MD, PhD, of Saint-Louis Hospital, Paris, France, who draws upon her center’s experience.

Managing patient wellbeing throughout the CAR T-cell treatment journey

The psychological wellbeing of patients receiving CAR T-cell therapy is an important factor that must be considered and managed alongside the physical treatment. Here, Prof. Thieblemont discusses the steps that her center has taken to address this, emphasizing the importance of good communication with the patient regarding the CAR-T treatment process.

Meeting the demand for CAR T-cell therapy at Kite: journey, collaboration & expansion

John Rossi, Director of Translational Medicine at Kite, a Gilead Company, discusses how Kite is approaching the scalability of CAR T-cell therapy.

Axicabtagene ciloleucel is indicated for the treatment of adult patients with relapsed or refractory diffuse large B-cell lymphoma (DLBCL) and primary mediastinal large B-cell lymphoma (PMBCL), after two or more lines of systemic therapy. Axicabtagene ciloleucel must be administered at a qualified clinical setting.

Adverse events should be reported. For the UK, reporting forms and information can be found at www.mhra.gov.uk/yellowcard.
For Ireland, reporting forms and information can be found at www.hpra.ie and can be reported to HPRA on +353 1 6764971.
Adverse events should also be reported to Gilead at safety_FC@gilead.com or +44 (0) 1223 897500.

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