When to refer leukemia and lymphoma patients for CAR T-cell therapy

CAR T-cell therapy for leukemia and lymphoma patients can be an incredibly effective treatment. That means understanding when to refer a patient for treatment is critical. 

Dr. David Maloney, Medical Director of the Bezos Family Immunotherapy Clinic at Seattle Cancer Care Alliance (SCCA), addresses this in a recent episode of the Oncology Sound Byte podcast.

SCCA currently offers FDA-approved CAR T-cell therapy treatments for acute lymphoblastic leukemia, relapsing or refractory diffuse large B-cell lymphoma, follicular lymphoma, and relapsed mantle cell lymphoma, and was one of the first centers in the country to offer all five.

Dr. Maloney says providers should consider referring patients:

• AFTER they’ve had the required lines of standard therapy
  
• BEFORE they have refractory disease;
• IF they’ve received a blood and marrow transplant and are not in a complete remission, and;
• When they have a relatively low amount of the disease in their body

“What we have learned so far is that patients who have the least amount of disease tend to have better outcomes and they tend to have less toxicity with the therapy,” Dr. Maloney said.

Toxicity refers to immune-related adverse effects of immunotherapy. For example, some people experience gastrointestinal toxicity during treatment, which can lead to symptoms like constipation or diarrhea, and nausea and vomiting.

“[I]f you can get the patients to CAR T-cell therapy before they have absolute refractory disease and very bulky lymphadenopathy, then it’s very likely that the outcome will be better and that they’ll have less toxicity through the process,” Dr. Maloney said. “The two major toxicities we see are cytokine release syndrome and neurologic toxicity and they both seem to be decreased in patients who have less disease bulk.”

SCCA is one of the first cancer centers in the U.S. to offer these FDA-authorized treatments for immunotherapy:

• Tisagenlecleucel, known by the brand name Kymriah®, available for adult patients with relapsed or refractory large B-cell lymphoma; also available for young adult patients with relapsed or refractory acute lymphoblastic leukemia
  
• Axicabtagene ciloleucel (axi-cel), known by the brand name Yescarta®, available for adult patients with relapsed or refractory large B-cell lymphoma, as well as relapsed or refractory follicular lymphoma
• Brexucabtagene autoleucel, known by the brand name Tecartus™, was approved to treat patients with mantle cell lymphoma (MCL)
• Lisocabtagene maraleucel, known by the brand name of Breyanzi®, was approved to treat adult patients with relapsed or refractory (R/R) large B-cell lymphoma

SCCA’s referral line can help you determine further if your patient is a good candidate for CAR T-cell therapy. And remember — don’t think of it as a last resort.

“If you’re just thinking about referring patients for this therapy, which we think can be curative in a substantial [number] of patients, then it’s better to think about it before you’ve exhausted every possible treatment option and refer them when they become eligible,” Dr. Maloney said.

Listen to the podcast in its entirety here:

On RadioMD with full transcription