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ASH 2024 | The logistical challenges of CAR T-cell therapy in non-Hodgkin lymphoma
Anna Sureda, MD, PhD, Catalan Institute of Oncology, Duran I Reynals Hospital, Barcelona, Spain, comments on the logistical challenges of CAR T-cell therapy in non-Hodgkin lymphoma (NHL), highlighting the need for optimized patient referral, efficient approval processes, and shorter manufacturing times. Prof. Sureda emphasizes the importance of ensuring patients have a good performance status and disease control before undergoing CAR-T therapy and notes that a significant proportion of patients (50-55%) ultimately do not receive the treatment due to having to wait four to six weeks for infusion after being identified as a potential candidate for CAR-T. This interview took place at the 66th ASH Annual Meeting and Exposition, held in San Diego, CA.
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Transcript (AI-generated)
CAR T-cell therapy constitutes nowadays a curative treatment strategy for patients with B-cell non-Hodgkin’s lymphoma, not only in third line or plus, but also in second line. We have two constructs that have been approved, basically axi-cel and liso-cel, to treat patients with primary refractory and early relapsed diffuse large B-cell lymphoma. And we have other constructs that have been approved also for follicular lymphoma, for mantle cell lymphoma, and of course for aggressive B-cell lymphoma in later lines of therapy...
CAR T-cell therapy constitutes nowadays a curative treatment strategy for patients with B-cell non-Hodgkin’s lymphoma, not only in third line or plus, but also in second line. We have two constructs that have been approved, basically axi-cel and liso-cel, to treat patients with primary refractory and early relapsed diffuse large B-cell lymphoma. And we have other constructs that have been approved also for follicular lymphoma, for mantle cell lymphoma, and of course for aggressive B-cell lymphoma in later lines of therapy. So even if they are considered a curative approach and they are gaining more and more space in the treatment of these diseases they represent logistical challenges and I would say that these logistical challenges are kind of multifactorial.
First of all, referral of patients needs to be optimized. We don’t have so many centers that have been approved or that have the possibility to treat patients with CAR-T, and many of these patients are being treated in smaller centers or centers that don’t have the capacity to treat patients with CAR-T. So, referring patients and referring patients on time with adequate performance status, I would say that is one of the most important things.
Then we have to fight against logistics and all the approval processes once a patient has been identified as a potential candidate to receive CAR-T. And of course, we have to fight against the long manufacturing processes that autologous CAR T-cell constructs have. So, from the time that we identify a patient as a potential candidate to receive CAR-T, by the time that this patient can be infused, depending a little bit on the countries, and of course depending or a little bit different between the US and Europe, where in the US the process is significantly quicker than in Europe. We have a time interval between four to six weeks in which we have to have the patient in good performance status and with the disease with a little bit of control to be able to take the patient in good condition to CAR-T. And we know from a real-world evidence analysis that around 50 to 55% of the patients eventually don’t make it. A little bit different from one country to the other one, and of course different from one disease to the other one. So still we need to work on all these challenges.
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