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ASCO 2026 | Expanding patient access to clinical trials after CAR-T failure in R/R LBCL
Dai Chihara, MD, PhD, The University of Texas MD Anderson Cancer Center, Houston, TX, discusses factors affecting clinical trial access after CAR-T failure in patients with relapsed/refractory (R/R) large B-cell lymphoma (LBCL). Dr Chihara highlights that approximately two-thirds of these patients are ineligible due to severe cytopenias and suggests that the field needs to re-evaluate safe cutoffs for eligibility criteria to ensure timely access to new treatments. This interview took place during the 2026 American Society of Clinical Oncology (ASCO) Meeting in Chicago, IL.
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Transcript
We analyzed, I think it was 166 patients who progressed after CAR T-cell therapy at MD Anderson Cancer Center from 2018 to 2023. And then what we found out was that for those patients who progressed at the CAR T-cell therapy, when you look at the eligibility criteria for pivotal trials that led to FDA approval, including like bispecific antibody or even loncastuximab tesirine, about only approximately one-third of the patients were eligible for such trials...
We analyzed, I think it was 166 patients who progressed after CAR T-cell therapy at MD Anderson Cancer Center from 2018 to 2023. And then what we found out was that for those patients who progressed at the CAR T-cell therapy, when you look at the eligibility criteria for pivotal trials that led to FDA approval, including like bispecific antibody or even loncastuximab tesirine, about only approximately one-third of the patients were eligible for such trials. So that means that the majority of the patients who progress after CAR T-cell therapy are not eligible for these pivotal trials. And then the major risk factor for them being ineligible for the trial was the cytopenia, including like thrombocytopenia and neutropenia. That means that the patient who progressed after CAR T-cell therapy has severe comorbidities, often have severe cytopenia that makes them ineligible for the study. I think we still need to discuss in the field what’s the safe cutoff for the eligibility criteria, including what the optimal platelet counts should be or what the optimal neutropenia or the neutrophil count should be. We need to deliver these new agents to patients as quickly as possible so I think the field needs to look into modifying you know the eligibility criteria for those patients who progressed after like all the available treatments.
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