ASH 2024 | Real-world practice patterns of physicians treating patients with MCL with CAR-T therapy

Yes, so this ASH meeting 2024, we presented some data which was presented in the form of poster on Sunday regarding the practice patterns of physicians who are treating mantle cell lymphoma patients with CAR T-cell therapy, mainly with brexu-cel in Europe. And this was conducted through EBMT. So what we wanted to analyze was the holding and bridging strategies that these physicians were using in the mantle cell lymphoma setting. That is to say, the treatment that patients received prior to leukapheresis, that’s what we call holding therapy, and the bridging therapy between leukapheresis and lymphodepleting chemotherapy. So we were especially interested in the use of targeted agents, BTK inhibitors, and venetoclax, because this is quite unique to the mantle cell lymphoma setting. What we identified is there was quite a high use of targeted approaches, both as holding and bridging. This varied according to the fact of patients presenting or not adverse prognostic factors with their mantle cell lymphoma. And what was interesting was the washout period before leukapheresis and before lymphodepleting chemotherapy. So there was a significant proportion of physicians, over 30%, who did not stop the BTK inhibitor. It was being used prior to leukapheresis and just maintained it through the apheresis period. They did, however, stop in almost all cases venetoclax, that was being used as well in the holding regimen. And of course, chemotherapy was stopped at least two weeks prior to leukapheresis. Regarding bridging therapy, there was a whole armamentarium of different regimens used. Patients with adverse prognostic features, usually there was a higher use of chemotherapy in combination with targeted approaches. And patients without adverse prognostic features, there was a high use of BTK inhibitor therapy and monotherapy, or combined with venetoclax. Prior to lymphodepleting chemotherapy and CAR T-cell therapy, again, venetoclax, if it was being used, was stopped to respect the washout prior to lymphodepleting chemotherapy and CAR T-cell therapy. But there was a significant proportion of physicians which maintained the BTK inhibitor across lymphodepleting chemotherapy, and approximately 15% even through the CAR T-cell infusion and after kind of the supportive data that has been published of the TARMAC trial and other studies supporting the role of BTK inhibitor across the CAR T-cell process and kind of ruling out the fact that it could impact negatively on CAR T-cell expansion. So physicians feel comfortable enough to maintain that agent across the CAR T-cell infusion.

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