CAR T-Cell Therapy Eligibility and Early Referral in Relapsed/Refractory CLL

Dr. Mazyar Shadman and Dr. Jennifer J. Huang discuss patient selection and referral timing for chimeric antigen receptor (CAR) T-cell therapy in relapsed/refractory chronic lymphocytic leukemia (CLL). Dr. Huang recommends considering CAR T-cell therapy for patients previously exposed to both a covalent Bruton tyrosine kinase (BTK) inhibitor and a B-cell lymphoma 2 (BCL-2) inhibitor. She emphasizes that referral may be appropriate even when patients are receiving pirtobrutinib or participating in a clinical trial, ideally while their disease remains controlled. Dr. Shadman highlights the importance of early consultation to allow time for treatment planning, caregiver arrangements, and discussion of the requirements and expectations of CAR T-cell therapy. Both experts stress that CAR T-cell eligibility differs from transplant eligibility and should be assessed individually based on each patient's treatment history and comorbidities. They encourage referring physicians to involve a specialized CAR T-cell center rather than making assumptions about eligibility, allowing experts to evaluate whether this treatment is an appropriate option for each patient.