Comorbidities and Patient Selection for CAR T-Cell Therapy in Large B-Cell Lymphoma

Dr. Melody and Dr. Perales discuss how comorbidities should be considered when evaluating patients with large B-cell lymphoma for CAR T-cell therapy. Using Mr. R's chronic kidney disease and hypertension as examples, Dr. Perales emphasizes that CAR T-cell eligibility should not simply mirror transplant eligibility or the restrictive criteria used in registrational trials. He highlights the importance of timely referral to a CAR T-cell specialist, noting that some potentially eligible patients may never reach a cell therapy center because eligibility decisions are made before specialist evaluation. The discussion explores how renal and cardiac function can influence treatment planning while allowing for individualized adjustments, including modifications to lymphodepletion and supportive strategies. Dr. Perales emphasizes that treatment decisions should be made on a case-by-case basis through informed discussions of potential risks and benefits. The panel concludes that few factors should automatically exclude a patient and that product selection, lymphodepletion, toxicity monitoring, and prophylactic approaches can be tailored to the individual patient.