CAR T-cell case study: Sequencing therapies for patients with high-risk DLBCL

Here, we share a presentation by Ulrich Jӓger, Medical University of Vienna, Vienna, AT, on a case study to evaluate sequencing therapies for patients with high-risk diffuse large B cell lymphoma (DLBCL).

The Lymphoma Hub has previously covered sequencing therapies for patients with high risk DLBCL.

In this presentation, Jӓger shares a case study from 2019 of a 59-year-old female patient with DLBCL and the treatment decisions leading to chimeric antigen receptor (CAR) T-cell therapy, changes from 2019 to 2022 onwards in the algorithm for patients with DLBCL in clinical routine (Figure 1), and results in relapsed/refractory (R/R) patients with low-risk DLBCL treated with CAR T-cell therapy, presented at the European Hematology Association (EHA) 2023 Hydrid Congress (Figure 2).

Figure 1. Selection algorithm for patients with DLBCL in clinical routine: Austrian CAR T-cell Network* 

*Adapted from Greinix, et al.¹

Figure 2. Probability of OS and PFS of patients with R/R LBCL infused with commercial CAR T-cell compounds* 

CAR, chimeric antigen receptor; CI, confidence interval; LBCL, large B-cell lymphoma; OS, overall survival; PFS, progression-free survival; R/R, relapsed/refractory
*Adapted from Rudzki, et al.^2
†Data from 65 patients treated with axicabtagene ciloleucel or tisagenlecleucel.

Watch or download the presentation to learn more about the understanding of CAR T-cell therapy in patients with DLBCL, including:

• A real-world evidence case study of a patient with DLBCL treated in 2019 according to the algorithm for patients with DLBCL in clinical routine.
• The key changes to the algorithm from 2019 to 2022 onwards, focusing on the removal of the requirement of no central nervous system (CNS) involvement in their diagnosis.
• Data presented from the 64th American Society of Hematology (ASH) Annual Meeting and Exposition on progression-free survival and overall survival in low-risk patients with DLBCL treated with CAR T-cell therapy.

Key points

• Special populations, such as patients with secondary CNS lymphoma, can be included in CAR T-cell treatments.
• Secondary CNS lymphoma can be successfully treated with CAR T-cell therapy.
• Sequencing capabilities have rapidly advanced since 2019 and earlier CAR T-cell therapy use in first-line high-risk DLBCL is recommended, while use in second line is a standard-of-care treatment for some lymphoma subtypes.
• CAR T-cell therapy is preferred to autologous stem cell transplant and complete response is no longer required.