Bridging Therapy and Site of Care in Large B-Cell Lymphoma

Dr. Shah discusses how bridging and holding therapy can be coordinated for patients with symptomatic or rapidly progressing large B-cell lymphoma who face logistical delays before CAR T-cell infusion. He explains that patients may experience delays related to consultation, insurance authorization, apheresis, and cell manufacturing, making interim disease control necessary for some patients. For patients who live far from a cell therapy center, Dr. Shah emphasizes the importance of partnering with the local oncology team to provide appropriate therapy closer to home. Treatment selection is individualized according to disease burden, symptoms, and the anticipated timeline to CAR T-cell therapy. He describes using less intensive approaches for patients with lower disease burden, while more cytoreductive regimens may be considered when greater disease control is needed. Other approaches may also be considered when CAR T-cell therapy is expected to be delayed. Dr. Shah emphasizes that the overarching goal of holding or bridging therapy is to maintain disease control while preserving the patient's ability to proceed to CAR T-cell therapy, avoiding treatment-related complications that could compromise CAR T-cell eligibility.