EHA 2025 | Insights from observational studies about aggressive non-Hodgkin lymphoma: CAR-T accessibility

So I think it’s in the name. Aggressive non-Hodgkin lymphoma can be very aggressive and can move very fast and while we have access to CAR T-cell therapy or many people around the world have access to CAR T-cell therapy, a very effective treatment for relapsed refractory aggressive B-cell lymphomas, it’s autologous so it’s not manufactured overnight and so we’ve got to have those patients referred early enough to work them up to get them apheresed quickly and then have access to effective bridging therapy to get their disease as best controlled as possible to get them to that CAR T-cell therapy. And so I think when you look at the real world data you see that there are a lot of patients who never make it to CAR T-cell therapy because they live rurally, because they’re too elderly or frail, because their disease simply moves too fast to allow CAR T-cell therapy, because they don’t respond or don’t have access to good bridging therapy and their disease blows out of control making CAR T-cell therapy futile by the time it’s manufactured. And so I think there have been now multiple real world studies both in the US and in other parts of the world showing that this population because of disease characteristics of patient characteristics and of logistical reasons it can be very hard to get them actually to CAR T-cell therapy. And I think that this should prompt us to ask two particularly important questions. The first is how can we make CAR-T more accessible to more patients? How can we streamline the logistics, the clinical aspects, the bridging therapy to try and allow more people to benefit from CAR-T? And also what are our other options? Things like the StarGlo trial which added glofitamab, a bispecific antibody, to gemcitabine oxaliplatin chemotherapy. Obviously all off-the-shelf products can be very attractive for either logistical reasons, cost reasons, other reasons, disease, you know, speed of disease reasons, because it’s, you know, instantaneously available. So I think that’s one example, but we have to look to what are other regimens that might be appropriate in situations where we don’t think CAR-T is going to be feasible. I mean, we certainly see patients in clinical practice whose disease won’t behave for long enough to get them to CAR T-cell therapy. So that definitely, I think, is an unmet need that’s highlighted by those observational data that we’ve seen.

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