Manali Kamdar, MD, on Transplant Eligibility Versus CAR-T Eligibility

This is the third part of an interview with Manali Kamdar, MD. For the second part, click here. For the first part, click here.

“Please if you think of a [patient with] refractory, diffuse LBCL in the second line setting or third line setting, please refer them to a CAR-T academic center or a community site capable of doing CD19 CAR-T ASAP because it is really of the essence to get the patient to a CAR-T physician. As you know, manufacturing time has to be accounted for, and for now, I can say the only cure I know of, which is the new standard of care, would be a CD19 CAR in the second line as well as in the third line setting.”

One of the key early line treatment options for patients with hematologic malignancies such as large B-cell lymphoma (LBCL) is allogeneic hematopoietic stem cell transplantation (allo‐HSCT). Although allo-HSCT has the potential to be curative, unfortunately some patients are ineligible to receive it, because of factors such as advanced age or a frail constitution that may put them at too high of a risk to endure the potentially serious adverse events (AEs) associated with allo-HSCT. In the second and third line settings for relapsed/refractory (r/r) LBCL, autologous chimeric antigen receptor T-cell (CAR-T) therapy, such as the CD19-directed lisocabtagene maraleucel (liso-cel, marketed as Breyanzi by Bristol Myers Squibb), can serve as another potentially curative option for patients. Because CAR-T also has certain potentially serious AEs associated with its use, some healthcare providers are inclined to equate allo-HSCT ineligibility with CAR-T ineligibility.

In a recent interview with CGTLive®, Manali Kamdar, MD, the associate professor of medicine–hematology and clinical director of lymphoma services at the University of Colorado, argued against this trend as an addendum to a larger discussion about results from the TRANSCEND-NHL-001 clinical trial (NCT02631044) evaluating liso-cel that were presented at the 66th American Society of Hematology (ASH) Annual Meeting and Exposition, held December 7-10, 2024, in San Diego, California. Kamdar emphasized her view that some patients traditionally deemed ineligible for allo-HSCT are perfectly capable of receiving CAR-T safely, and that such patients should be referred to a center capable of providing CAR-T as soon as possible in order to ensure better treatment outcomes.

For more coverage of ASH 2024, click here.

REFERENCE
1. Abramson JS, Palomba ML, Gordon LI, et al. Five-year survival of patients (pts) from Transcend NHL 001 (TRANSCEND) supports curative potential of lisocabtagene maraleucel (liso-cel) in relapsed or refractory (r/r) large B-cell lymphoma (LBCL). Presented at: ASH 2024 Annual Meeting. December 7-10, 2024; San Diego, CA. Abstract 3125