The evolving treatment paradigm of chimeric antigen receptor T-cell therapy in lymphoma

The field of chimeric antigen receptor (CAR) T-cell therapies is rapidly evolving. The number of approved indications for the existing CAR-T products is increasing, and, in parallel, so too is the number of novel products and disease targets being evaluated. Being able to navigate the available evidence is a priority for every hemato-oncologist.

Long-term follow up from pivotal trials, as well as real-world studies of commercial products in a range of B-cell non-Hodgkin lymphoma (B-NHL) have confirmed their ability to produce durable disease control with a manageable toxicity profile in a significant proportion of patients, including populations generally excluded from clinical trials. Nonrelapse morbidity and mortality risk profiles have been better established with long-term follow up, and risk reduction via antimicrobial prophylaxis and monitoring of hematologic recovery are being integrated as part of standard of care for these patients beyond the first-year posttreatment.

A significant proportion of B-NHL patients can achieve long-lasting remission after CAR-T. Ongoing efforts have identified demographic and disease characteristics associated with optimal response and toxicity. Novel products targeting alternative B-cell antigens or utilizing an allogeneic platform might be an option for those whose disease recurs after anti-CD19 CAR-T, with multiple studies ongoing to define their role in the treatment algorithm.