Dr. Braunschweig on Selecting Between Transplant and CAR T-Cell Therapy in DLBCL

Ira Braunschweig, MD, director, Stem Cell Transplant Program, clinical program director, Hematologic Malignancies, Montefiore Medical Center, associate professor, Department of Medicine (Oncology), Albert Einstein College of Medicine, discusses factors to consider when selecting between autologous stem cell transplant (ASCT), allogeneic stem cell transplant (allo-SCT), and CAR T-cell therapy in diffuse large B-cell lymphoma (DLBCL).

In patients with chemotherapy-sensitive DLBCL, ASCT remains the standard of care, says Braunschweig. This is likely due to the fact that the field has decades worth of experience in treating this patient population with ASCT.

However, CAR T-cell therapy appears to be the clear treatment choice for patients with primary refractory DLBCL, Braunschweig explains.

Historically, patients who progressed after ASCT received an allo-SCT, which can have curative potential, says Braunschweig. However, many patients experience graft-versus-host disease and ongoing health issues following allo-SCT.

Alternatively, if patients can tolerate the toxicities that tend to arise within the first few weeks after CAR T-cell therapy, they have a decreased risk for long-term health issues compared with allo-SCT, Braunschweig says.

Moreover, unlike with transplant, CAR T-cell therapy eliminates the need to aggregate antitumor response, which may make it a more appealing option for patients, concludes Braunschweig.