Dr. Pagel on the Utility of CAR T-Cell Therapy in Relapsed/Refractory DLBCL

John M. Pagel, MD, PhD, chief of the Hematologic Malignancies Program, and director of the Hematopoietic Cell Transplantation Program at Swedish Cancer Institute in Seattle, Washington, discusses the utility of CAR T-cell therapy in patients with relapsed/refractory diffuse large B-cell lymphoma (DLBCL).

Although autologous stem cell transplant (ASCT) is still used in DLBCL, it is important to understand that it is not a viable treatment option for the vast majority of patients who relapse, says Pagel. For example, if 60 out of 100 patients are cured, that means 40 patients will relapse, adds Pagel; of those 40 patients, approximately half will receive an ASCT. Patients will not get a transplant if they are not chemotherapy sensitive or they may have comorbidities that do not allow them to undergo the procedure.

Moreover, only about half of patients who under transplant will achieve cure, adds Pagel. Patients who are not cured up front or by transplant still need an effective treatment option that can provide a significant benefit. To this end, some newer agents have emerged for patients with relapsed disease in recent years. The biggest development has been CAR T-cell therapy, says Pagel. This approach provides curative potential to patients who failed a transplant; were never able to get to transplant because they are not sensitive to chemotherapy; or were high-risk and refractory to up-front rituximab (Rituxan) plus cyclophosphamide, doxorubicin hydrochloride, vincristine sulfate, and prednisone chemoimmunotherapy.

CAR T-cell treatments are very important for those patients, adds Pagel, as this approach can provide long-term survival to some of these patients, concludes Pagel.