EBMT 2022 | Strategies to implement CAR-T in DLBCL

Diffuse large B-cell lymphoma is one of the most frequent histological subtypes of non-Hodgkin lymphoma. We can cure these patients in a significant proportion with conventional chemoimmunotherapy strategies, but we have some patients that in spite of first-line treatment, or eventually second-line treatment, they demonstrate to have refractory disease or a relapsed disease.
The standard of care in patients with primary refractory, or secondary refractory disease, or patients with early relapse after autologous stem cell transplantation gives quite poor results in the long run, and this is why the introduction of three different CD19 CAR-T constructs some years ago was a revolution in this field and it significantly improved the long term of patients that otherwise had very poor prognosis. Nowadays we have really consolidated data on the different CD19 CAR-T constructs, both in efficacy and also in toxicity in patients with large B-cell lymphoma that have failed at least two prior treatments. And this has led to the introduction of CAR-Ts as a treatment option. Nowadays we have the results of three Phase III prospective clinical trials that compare CAR-T with the standard of care in patients with primary refractory disease or with early relapse. And two of these trials have offered positive results. Maybe in the future, we will be able to see CAR-Ts moving to second-line of treatment outside prospective clinical trials in these patients.