Transplant Eligibility Versus CAR-T Eligibility

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

Five-year survival data from patients treated in the large B-cell lymphoma (LBCL) cohort in the TRANSCEND-NHL-001 clinical trial (NCT02631044) evaluating Bristol Myers Squibb’s lisocabtagene maraleucel (liso-cel, marketed as Breyanzi), an autologous CD19-directed chimeric antigen receptor (CAR) T-cell therapy approved by the FDA for the treatment of third-line relapsed/refractory (r/r) LBCL, were recently presented at the 66th American Society of Hematology (ASH) Annual Meeting and Exposition, held December 7-10, 2024, in San Diego, California. In light of the results indicating curative potential of the CAR-T therapy in this setting, CGTLive® reached out to Manali Kamdar, MD, the associate professor of medicine–hematology and clinical director of lymphoma services at the University of Colorado, to get her insight on the key takeaways from the updated data.

After weighing liso-cel against CD20-bispecific T-cell engagers (BiTEs), another class of treatment options for patients in the third-line LBCL setting, Kamdar spoke about patient eligibility for liso-cel. She stated that patients who are deemed ineligible for allogeneic hematopoietic stem cell transplantation (allo‐HSCT), which is sometimes given as an earlier line treatment option with curative potential, may still be eligible for liso-cel. As such, Kamdar emphasized the importance of referring such patients to a CAR-T physician.

CGTLive: With regard to the new liso-cel data, do you have any main message for doctors?

Manali Kamdar, MD, PhD: I think, for diffuse LBCL, liso-cel and axicabtagene ciloleucel have been approved in the second-line r/r transplant-eligible LBCL setting, liso-cel has been approved in the transplant-ineligible second-line and higher setting, CD20 BiTEs are approved in the third-line setting (but then so are CARs)—you know, a lot of times I think we look at patients and assess their eligibility for CARs and equate that to transplant eligibility. I think someone being transplant-ineligible is not equivalent to CAR-T ineligible. A patient who is significantly older, potentially a little frailer, is perfectly capable of moving forward with the CD19 CAR T-cell therapy. So all I can say is: 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 as soon as possible 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.

This transcript has been edited for clarity.

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REFERENCE
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