IACH 2021 | Practical considerations in CAR-T therapy

We also will discuss in the meeting CAR T-cell therapy, which is really revolutionized the field. So, we have a lot of evolution but a lot of progress in the novel therapies. For the patient, and also for the physician, it’s a very good time to be now in the field of hematology and transplantation.

So, for the CAR T-cell in immunotherapy, for lymphoma, for ALL, and also the recently was approved, the first commercial product for multiple myeloma. So, for lymphoma, the main indication for a CAR T-cell therapy. We have four approved commercial products and the many academic studies going on, there is starting to release of the studies that compare upfront a patient that relapsed lymphoma, a diffuse large B-cell lymphoma, autologous transplant versus CAR T-cells and at least in two of the studies, there was improvement in the disease-free survival, not yet to overall survival for the CAR T-cells compared to the autologous transplantation. The cell study was a bit different because patients were allowed to get chemotherapy after the relapse.

So, choosing the patient for CAR T-cell and choosing the product is becoming an issue. And of course, when the patient need to is that we are offering them CAR T-cells, need first of all to be in the indication for the commercial CAR T-cell approved indication. Their tumor have to be stable for three, four weeks till the CAR T-cell are produced. If not, we need to give a bridging therapy. They need to have a good organ function, because otherwise a complication with CAR T-cells are higher. They also, I mean, there are now some kind of a scales for the toxicity of CAR T-cell toxicity to CAR T-cell, mainly the cytokine release syndrome and ICANS and the neurological toxicity, its proportion is higher if patient have higher tumor mass. And we have some factors that predict the response to CAR T-cells, including the tumor volume and PET/CT, extra-nodular disease. This is for lymphoma, and in high LDH or low platelets upfront, and for ALL.

On top of this, with P53 mutation is also a poor prognostic factor for CAR T-cells. So, we have today, we are developing skills to predict response to CAR T-cell and to predict toxicity. This is very important because more and more patients will ask and be referred to a CAR T-cell therapy and we need to decide to select the patient that will, the risk of therapy will be optimal for them and they will get, gain, the most of this therapy.