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ICML 2025 | Experience with the RESTART protocol: integrating radiotherapy into the peri-CAR-T setting for LBCL
Andrea Kuhnl, MD, King’s College Hospital, London, UK, comments on the UK experience with the RESTART protocol, a prospective study that integrates radiotherapy into the peri-CAR T-cell therapy setting for large B-cell lymphoma (LBCL). Dr Kuhnl reports encouraging results, with a 12-month progression-free survival (PFS) of 57%. The protocol was well tolerated, and no higher-grade toxicity from radiotherapy was observed. This interview took place during the 18th International Conference on Malignant Lymphoma (18-ICML) in Lugano, Switzerland.
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Transcript
So, RESTART is a prospective protocol implementing radiotherapy into the peri-CAR-T setting for large B-cell lymphoma. So, patients either get radiotherapy as bridging or as an early consolidation after CAR-T to lesions not showing a deep remission on the one-month PET scan. If we used radiotherapy early after CAR-T infusion, we tried to apply CAR-T sparing techniques to avoid destruction of circulating CAR-T cells in the peripheral blood...
So, RESTART is a prospective protocol implementing radiotherapy into the peri-CAR-T setting for large B-cell lymphoma. So, patients either get radiotherapy as bridging or as an early consolidation after CAR-T to lesions not showing a deep remission on the one-month PET scan. If we used radiotherapy early after CAR-T infusion, we tried to apply CAR-T sparing techniques to avoid destruction of circulating CAR-T cells in the peripheral blood. We’ve so far included 190 patients in the RESTART protocol with so far excellent results. So we see no higher grade toxicity from radiotherapy so this was overall very well tolerated. We see high local control rates both for radiotherapy bridged and consolidated patients and we see quite favourable post-CAR-T outcomes, so 12 months progression-free survival of 57%. Interestingly we even saw favourable outcomes in those higher risk patients who were deemed to require systemic bridging therapy and then didn’t achieve deeper remission. So one could speculate that addition of consolidation radiotherapy might have contributed to improving their outcomes.
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Disclosures
Consultancy: Kite Gilead, Roche, Abbvie, BMS; Honoraria: Kite Gilead, Astra Zeneca.
