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EBMT 2025 | Studying CAR-T outcomes after prior B-cell directed immunotherapy in aggressive B-cell malignancies
In this video, Jan Schröder, MD, Tübingen University Hospital, Tübingen, Germany, discusses the rationale for the development of a project that aims to study the impact of prior B-cell directed immunotherapy on the outcome of CD19 CAR T-cell therapy in patients with aggressive B-cell malignancies. Dr Schröder highlights that, with the advent of a range of novel treatment options, many questions remain around the optimal sequencing of therapeutic strategies and that more data is needed in this area. This interview took place at the 51st Annual Meeting of the EBMT in Florence, Italy.
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Transcript
Everyone knows now in the field that there have been tremendous advancements in the treatment of high-grade B-cell lymphomas with the advent of immunotherapy like CAR T-cell therapy, but also bispecific antibodies, ADCs and others. And as these very effective agents move into earlier lines, what is now becoming an increasingly difficult question is to sequence these therapies...
Everyone knows now in the field that there have been tremendous advancements in the treatment of high-grade B-cell lymphomas with the advent of immunotherapy like CAR T-cell therapy, but also bispecific antibodies, ADCs and others. And as these very effective agents move into earlier lines, what is now becoming an increasingly difficult question is to sequence these therapies.
There is consensus among experts now that many patients, especially refractory with early relapses, should really go on to receive CAR-T in the second line already, with the other agents being reserved for later treatment which might be sensible, which kind of also comes from the thing that there are overlapping antigens, right? There’s CD19 CAR-T and then you have CD19 ADCs and you have CD19 bispecifics. However, we have also, I mean everyone is exposed to rituximab, and the CD20 bispecifics are also on the market. So maybe this might not be that big of an issue. There is data that for example, for tafasitamab CD19 sequencing with CD19 CAR-T does not pose that big of a problem. But we have a lack of data on that, especially in Europe. But the good thing is that with the EBMT registry, we have a very, very vast resource to address this.
And so some time ago already we asked this question and together, this is a tandem project together with colleagues from Münster, we teamed up with the Go-CART coalition. We won a proposal for a retrospective research project in the excellence package in ’23. And we are now presenting today like the interim analysis of the recruitment in progress. So we have now included 28 centers from Europe. Probably in the end, the case number will be something around 1000 or 1200. And from these patients, we have all information on prior treatment lines to CAR T-cell therapy. And the question is, of course, so what is the impact of different types and the timing of earlier B-cell directed immunotherapy in these patients?
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