Dr. D’Angelo on Selecting CAR T-Cell Therapy or Transplantation in DLBCL

Christopher R. D’Angelo, MD, an assistant professor in the Department of Internal Medicine, Division of Hematology/Oncology at the University of Nebraska Medical Center, discusses factors that determine whether CAR T-cell therapy or autologous stem cell transplant should be used in patients with relapsed/refractory diffuse large B-cell lymphoma (DLBCL).

For some patients, there may be some concern about potential responses to salvage chemotherapy, D’Angelo says. If a patient demonstrates a mixed response with some tumor shrinkage but stability in other lesions, that may raise the question as to how durable that treatment is and how chemotherapy-sensitive the patient is, D’Angelo explains. As such, that may serve as the rationale for utilizing CAR T-cell therapy over salvage chemotherapy while trying to remain within the strict criteria for its use, D’Angelo notes.

At the same time, it is important to recognize that there is a patient population where questions remain as to how well transplant will work, as well as whether it is worth the associated toxicities if they are going to relapse. If patients are going to relapse or are chemotherapy refractory, it is difficult to begin selecting a simultaneous next-line therapy while patients are still recovering from autologous stem cell transplant, D’Angelo concludes.