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A recent peer-reviewed study published in Blood Advances highlights the importance of early identification and referral of patients with large B-cell lymphoma (LBCL) who may benefit from CAR T-cell therapy.
The study, “Real-world treatment patterns of patients with large B-cell lymphoma over time and into a post–CAR T approval era,” was conducted by investigators at Memorial Sloan Kettering Cancer Center and represented a retrospective analysis of the US Flatiron Health Research Database. It included 10,016 patients diagnosed with LBCL from 2011–2024 who initiated first-line therapy. Most were treated in community oncology practices (75%), the median age was 69, and R-CHOP was the most common first-line regimen (83%).
Major Findings:
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Early mortality was substantial. Overall, 13% (1,328 patients) died within 12 months of beginning first-line therapy without ever starting second-line treatment, while only about 30% initiated 2L therapy.
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CAR T use was surprisingly low even among patients considered fit and eligible. Only 25% (32/128) of clearly fit patients eligible for second-line CAR T actually received CAR T. Among clearly fit patients eligible for third-line CAR T, 35.7% (65/182) received it. Many instead received chemoimmunotherapy or other therapies.
- The authors suggest several possible barriers: referral delays, treatment-center distance, cost/reimbursement issues, caregiver requirements, socioeconomic disparities, patient preference, and the complexity of CAR T delivery.
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The authors therefore argue for earlier identification of high-risk patients, earlier CAR T referral, closer coordination between community oncologists and CAR T centers, proactive planning during first-line therapy, and better patient access/awareness.
Conclusions:
The study suggests that the problem in real-world LBCL isn't simply whether CAR T works. A major problem is getting appropriate patients to CAR T soon enough. Many patients die before reaching second-line treatment, and only a minority of apparently fit, eligible patients receive CAR T once they do.
For eligible patients, timely evaluation is critical to ensure access to this curative treatment option.
Our team is experienced in the evaluation and management of complex relapsed/refractory non-Hodgkin lymphoma and can urgently assess appropriate patients and expedite the CAR T-cell treatment process when indicated.
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