EBMT 2026 | Overcoming common misconceptions about CAR-T in DLBCL

So, with respect to addressing misconceptions with the use of CAR T-cells in patients with diffuse large B-cell lymphoma, I want to basically address two specific topics. First of all, the fact that eligibility criteria for patients being treated with CAR-Ts are not the same as eligibility criteria for patients being treated with autologous stem cell transplantation, which has been the cellular therapy strategy that we have been using for many years in patients with diffuse large B-cell lymphoma. Age should not be an issue when considering a patient as a potential candidate to receive CAR-T, and as opposed to autologous stem cell transplantation, where we have an upper age limit between 65 and 70 years of age, there is no official upper age limit when we consider a patient potentially a candidate to receive CAR T-cell therapy. The second misconception that I want to address with respect to eligibility criteria to treat patients with CAR-T is the issue of comorbidities. And comorbidities have a higher significant impact or a higher impact in the results of autologous stem cell transplantation than in the results of CAR-T. So we are a little bit more flexible when considering cardiac, pulmonary, and renal comorbidities when we take into consideration a patient as a potential candidate for CAR-T. So basically, in summary, the eligibility criteria to consider a patient candidate for a CAR T-cell therapy is wider than when we consider a patient candidate for an autologous stem cell transplantation. 

Then the second topic that is important to be addressed is that if the patient is eligible for CAR-T in second line, CAR-T should be used in second line and this treatment should not be deferred to third line or posterior lines of therapy. First of all, although we cannot compare different prospective clinical trials, in principle, progression-free survival is better in those patients that are being treated with CAR-T in second line than when we leave CAR-T for third line or plus. And second, I think that we have to take into consideration the fact that when we consider treatment with CAR T-cells in a third line or plus, we have a more heavily pretreated patient in front of us. We potentially have patients with a poorer performance status, and we also need to take into consideration that T-cell fitness is being affected with prior treatment. So in principle, the cellular product that we are going to collect in patients that have failed only one prior line of therapy is going to be a healthier product with T-cells that are better fit than those products that are being collected in patients that have failed two or more lines of prior therapies.

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