Relapsed/Refractory Diffuse Large B-Cell Lymphoma and Mantle Cell Lymphoma: Is It Time to Consider CAR-T for All?
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CAR T cells have demonstrated activity in relapsed/refractory non-Hodgkin lymphoma, including diffuse large B-cell lymphoma (DLBCL), indolent non-Hodgkin lymphoma, and mantle cell lymphoma. For patients with chemorefractory disease, CAR T cells can provide a durable complete response in a portion of patients, which represents a major advance in the field. For patients with chemosensitive disease, however, additional data are needed to determine whether CAR T cells are preferable to conventional approaches. Studies in DLBCL have shown that patients experiencing a PET-positive partial response after second-line chemotherapy have long-term outcomes after high-dose therapy and autologous stem cell rescue that are similar to CAR T-cell therapy, with decreased toxicity and cost. Alternative third-line options such as tafasitamab/lenalidomide and bispecific antibodies may also have a role for patients with chemorefractory disease.
Disclosures: Dr. Zelenetz has disclosed that he has received grant/research support from BeiGene, Gilead Sciences, Inc., MEI Pharma Inc., and Roche Laboratories, Inc.; has received consulting fees from Adaptive Biotechnologies Corporation, Amgen Inc, BeiGene, Celgene Corporation, Genentech, Inc./Roche Laboratories, Inc., Gilead Sciences, Inc., Janssen Pharmaceutica Products, LP, Novartis Pharmaceuticals Corporation, and Verastem Oncology; and is a Scientific Advisor for AbbVie, Inc, AstraZeneca Pharmaceuticals LP, Genentech, Inc., Gilead Sciences, Inc., MorphoSys AG, and Pharmacyclics.
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