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Consensus Opinion Addresses Concerns About Clinical Application of CAR-T

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The
American Society for Transplantation and Cellular Therapy recently released an
expert opinion on the clinical application of CD19-directed chimeric antigen
receptor T-cell (CAR-T) therapy in B-cell non-Hodgkin lymphoma (NHL).1

There are
currently 2 CD19-directed CAR-T therapies that have been approved by the US
Food and Drug Administration: axicabtagene ciloleucel (Yescarta) and
tisagenlecleucel (Kymriah). Given the recent introduction of these treatments,
concerns still exist about their clinical application.

“The aim
of this article is to provide consensus opinion from experts in the fields of
hematopoietic cell transplantation, cellular immunotherapy, and lymphoma
regarding key clinical questions pertinent to the utilization of CD19 CAR T for
the treatment of NHL,” the expert panel wrote. “As the clinical practice using
CAR T cells grows worldwide, we anticipate that this guidance will be relevant
for hematology/oncology physicians who care for patients with lymphomas.”

The
expert panel convened for this opinion focused on 10 key clinical questions
pertaining to CAR-T, and provided a detailed consensus opinion for each.

A summary
of their recommendations includes:

  • Early referral for consideration for CAR-T
    in patients with relapsed or refractory disease
  • Using disease volume, prior response to
    therapies and comorbidities to guide decisions about choice of bridging therapy
  • Consider CAR-T in patients who have
    undergone a prior autologous or allogeneic transplant
  • Monitor patients for cytokine release
    syndrome and immune effector cell-associated neurotoxicity syndrome after
    treatment
  • Monitor patients for cytopenias,
    hypogammaglobulinemia, and infection, and treat as clinically indicated
  • Use PET/CT for initial staging at day +30
    and day +90. If complete response is achieved, CT imaging is appropriate for
    follow-up

Correction: This article was updated on 9/12/19 to reflect the fact that that the American Society of Hematology did not, in fact, collaborate on the manuscript as previously stated.

Disclosure: Some of the authors disclosed
financial ties to the pharmaceutical industry. For a full list of disclosures,
please refer to the original study.

Reference

Jain T, Bar, M, Kansagra AJ, et al. Utilization of chimeric antigen receptor (CAR) T Cell therapy in clinical practice for relapsed/refractory aggressive B cell non-Hodgkin lymphoma: An expert panel opinion from the American Society for Transplantation and Cellular Therapy [published online August 22, 2019]. Biol Blood Marrow Transplant. doi: 10.1016/j.bbmt.2019.08.015

This article originally appeared on Cancer Therapy Advisor

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