CAR-T Cell Therapy in Large B Cell Lymphoma

• Published in: Mediterranean journal of hematology and infectious diseases 2023, Vol.15 (1), p.e2023066-e2023066
• Main Authors: Testa, Ugo, Leone, Giuseppe, Pelosi, Elvira, Castelli, Germana, Hohaus, Stefan
• Format: Article
• Language: English
• Subjects: CAR-T; Large Cell B-Lymphoma; Salvage therapy
• ISSN: 2035-3006; 2035-3006
• DOI: 10.4084/MJHID.2023.066

Large B-cell lymphomas (LBCLs) are among the most frequent (about 30%) non-Hodgkin's lymphoma. Despite the aggressive behavior of these lymphomas, more than 60% of patients can be cured with first-line chemoimmunotherapy using the R-CHOP regimen. Patients with refractory or relapsing disease show a poor outcome even when treated with second-line therapies. CD19-targeted chimeric antigen receptor (CAR) T-cells are emerging as an efficacious second-line treatment strategy for patients with LBCL. Three CD19-CAR-T-cell products received FDA and EMA approval. CAR-T cell therapy has also been explored for treating high-risk LBCL patients in the first-line setting and for patients with central nervous system involvement. Although CD19-CAR-T therapy has transformed the care of refractory/relapsed LBCL, about 60% of these patients will ultimately progress or relapse following CD19-CAR-T; therefore, it is fundamental to identify predictive criteria of response to CAR-T therapy and to develop salvage therapies for patients relapsing after CD19-CAR-T therapies. Moreover, ongoing clinical trials evaluate bispecific CAR-T cells targeting both CD19 and CD20 or CD19 and CD22 as a tool to improve the therapeutic efficacy and reduce the number of refractory/relapsing patients.