CAR T-Cell Therapy Safe, Feasible for Patients With Lymphoma in Complete Remission Before Cell Therapy Begins

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Data presented at the 2023 ASH Annual Meeting & Exposition suggest that chimeric antigen receptor (CAR) T-cell immunotherapy remains a viable option for patients who have lymphoma that goes into remission before the cell therapy begins (Abstract 615).

While the findings do not answer the question of whether giving cell therapy to these patients who are in remission is the right choice, they do say that it’s not the wrong choice, said the study authors.

“I don’t think it answers the question of: should we give these patients cell therapy? But I think it answers the question that we can—that it’s safe and that it’s a reasonable strategy when you’re in that spot,” said lead author Trent Wang, DO, a hematologist and cellular therapy specialist at the Sylvester Comprehensive Cancer Center at the University of Miami Miller School of Medicine.

Study Background

Dr. Wang noticed an odd phenomenon in the past few years when treating patients with lymphoma with this form of therapy: some of his patients went into complete remission before ever receiving treatment. This uncommon scenario occurs during the process of getting to CAR T-cell infusion. When a patient starts the process, there is a waiting period of 3 to 5 weeks to get to treatment. Insurance approval is needed, and the cells themselves need to be manufactured from the patient’s own cells. In the interim, physicians will often treat these patients with a short course of chemotherapy or other drugs to control their disease symptoms. A small number of patients end up in remission during this waiting period treatment, the clinicians have found.

“That prompted this dilemma: now what are we supposed to do?” Dr. Wang said. “Should we change the plan or give the therapy anyway? We just didn’t have a lot of information on this scenario.”

Dr. Wang said more often than not, his team would proceed with the cell therapy in these cases, mainly to prevent yet another stretch of time where the patients’ cancer might come back again. He and his colleagues noticed that their patients who received the cells while in remission tended to fare well after their infusion. But they didn’t know if those results would hold up in an analysis of a larger group. They proposed a research study to the Center for International Blood & Marrow Transplant Research.

Registry Analysis

The study included data from 134 patients in the registry who had gone into complete remission in the waiting period before receiving their cell therapy. To find that group, the scientists screened the records for more than 5,000 recipients of cell therapy.

They found that this group of patients had a 43% probability of progression-free survival over the 2 years following their treatment—about the same percentage as patients in the registry who were not in remission when they received CAR T-cell therapy. However, the patients in remission had very low levels of toxicities related to their cell therapies—namely, a reduced chance of developing cytokine-release syndrome and neurotoxicity.

The study used data from patients treated with CAR T-cell therapy between 2015 to 2021, and current frequencies of specific cell therapy use are slightly different from those that were used in practice just a few years ago, Dr. Wang said. Next, the researchers want to explore the data paralleling more recent treatment trends.

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