EHA 2025 | Ask the Expert: Anna Sureda answers your lymphoma questions at EHA 2025

Hello everybody, my name is Anna Sureda. I am the head of the Clinical Hematology Department at the Catalan Institute of Oncology in Barcelona, Spain. I am also the president of the EBMT and I want to welcome all of you to EHA 2025 here in Milan in Ask the Expert. 

So the first question I have here is do you think there is a role for autologous stem cell transplantation in patients with large B-cell lymphoma who relapse after CAR-T and respond to a subsequent line of therapy? I think that this is an interesting question and I’m not so sure if we are going to have a clear answer for that. Autotransplant has been the standard of care in patients with primary refractory or relapsed diffuse large B-cell lymphoma that respond to second-line therapy and we know that auto transplant can be a curative treatment strategy in this specific setting. With the advent of CAR-Ts in second line we are not doing auto-wilder stem cell transplantation in these patients but we know that still around 50% of the patients will fail CAR-Ts so we have to think which is the best treatment strategy. We are trying in some ways to avoid giving more chemotherapy to the patients, but we have to admit that patients that are failing CAR-T have not really received a lot of chemotherapy before. So we may think that salvage chemotherapy and if response being consolidated with an autologous stem cell transplantation might be a way to go. On the other side, we have many new drugs that have also demonstrated to be effective in this specific setting. And I think that we should be able to generate more data, probably coming from real world data to better answer this question. But I would think that this might be a treatment option for these patients. 

So the second question here is, How are you bridging most of your second line CAR T-cell patients? This is also another open question. We don’t have a standard of care, and we have to take into consideration, first of all, the performance status of the patient. Second, the treatment strategy that the patient has received before, and eventually toxicities of the prior lines of therapies that the patient has received. And third, if the patient has localized relapse or has systemic relapse. The other thing that we have to take into consideration is the availability and the reimbursement of potential new drugs in this specific setting. So I would say that when we have a localized relapse for a patient that is candidate to receive a CAR T-cell therapy, radiotherapy can be a very good option. Radiotherapy is effective treatment for patients with localized disease. We have to expect less toxicity in this specific setting and probably a good response. If we have systemic relapse, a widespread relapse, of course, radiotherapy is not an option. And here we have to take into consideration the prior treatment that the patient has received and also the treatment options that we have. There are some retrospective analysis that indicate that polatuzumab-containing regimens can be an effective treatment option to bridge these patients into CAR-T cells. If we don’t have the possibility to use polatuzumab, then we will have to continue with additional or with other salvage treatment strategies that the patient has not received. We have some data, probably not in the second line setting, but in later lines of therapy where bridging patients with bispecific monoclonal antibody can also be an option. But of course, in many places, we don’t have the possibility to use bispecific monoclonal antibodies. And this remains, I would say, an area of future research. 

So the next question is, how are you selecting patients for third-line CAR-T or third-line bispecific monoclonal antibodies? So I think that this question probably, at least in our setting, was more relevant a few months ago or a while ago because we didn’t have the possibility to use CAR-T in second line. Nowadays, we have CAR-Ts in second line and probably outside prospective clinical trials, patients that relapse after CAR-Ts second line, we would consider bispecific monoclonal antibodies in them. When we were using CAR T’s in third line, I have to say that the possibility to use bispecifics in third line or plus was not an option, at least in Spain. Nowadays we have these two possibilities and let’s say the decision of using CAR-Ts or bispecifics from my point of view is kind of relying on the profile of the patient. If we have patients with rapidly evolving disease, with very aggressive disease, probably these patients would eventually benefit more from having an off-the-shelf treatment such as bispecifics that will be able to eventually control the disease progression in a quicker period of time. If the patient has relapsed disease but we think that the disease can be controlled during this period of time where we are collecting the lymphocytes and we are manufacturing CAR-T. We have more consolidated data even in third line with CAR-T in front of bispecific and of course, if the institution, the center of the patient has the possibility to receive CAR-T, maybe that should be the treatment option. Of course, in this decision-making process, we have to take into consideration the accessibility of the patient to CAR-T, which is not the case in many centers and in many areas around the world. So I would say that if CAR T-cells are not available, bispecific could represent an excellent treatment option for these patients. 

So, I have the last question here. What advice would you give early career physicians who want to specialize in transplant and cellular therapy? So, first of all, I would like to encourage all young physicians to demonstrate interest and to go into the transplant and cellular therapy field in hematology, which is basically what I have done for many many years. It’s nowadays really a moving field with many new developments with the possibility to use new treatment strategies that we were not able to have in the past so I think that from a scientific point of view it’s really challenging and it’s an area of highly scientific interest. I think that we have to be really very proactive here, we have to work on educational strategies so you need to let’s say to work on educational programs to be as proficient as possible in this specific field and, of course, you have to be really encouraged and you need to find good mentors basically to make it happen. Thank you very much for your attention.

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