Dr Kamdar on Optimizing Patient Monitoring After Liso-Cel in MCL

“CAR T-cell therapy has revolutionized outcomes in [patients with] B-cell malignancies. Patients have been able to achieve durable remissions. However, irrespective of the CAR T-cell therapy construct as a function, we have to manage the unique adverse [effects] of CD19[-directed] CAR T-cell therapy.”

Manali Kamdar, MD, an associate professor of Medicine-Hematology and the clinical director of Lymphoma Services at the University of Colorado Anschutz Medical Campus, discussed the rationale for optimizing patient monitoring after CD19-directed CAR T-cell therapy lisocabtagene maraleucel (liso-cel; Breyanzi) in patients with relapsed/refractory large B-cell lymphoma, chronic lymphocytic leukemia/small lymphocytic lymphoma, follicular lymphoma, and mantle cell lymphoma (MCL).

In recent years, CAR T-cell therapies, including liso-cel, have significantly shaped the treatment landscape for patients with B-cell malignancies, Kamdar began. She noted that despite the CAR T-cell therapy construct, the management of unique adverse effects (AEs) caused by CAR T-cell therapies needs to be considered, including cytokine release syndrome (CRS) and immune effector cell-associated neurotoxicity syndrome (ICANS), which are typically manageable. Nevertheless, because these AEs are unique, patients are required to stay within 30 miles of the treating academic center for 4 weeks, she explained. Consequences of this mandate involve logistical barriers and socioeconomic challenges that could affect access to receiving CAR T-cell therapy, she emphasized.

Thus far, liso-cel has demonstrated robust efficacy data, durable remissions, and a manageable safety profile, which has led the FDA to approve the CAR T-cell therapy in several B-cell malignancies, Kamdar added. Specifically, in May 2024, the FDA approved liso-cel for the treatment of patients with relapsed/refractory MCL after receiving at least 2 prior lines of systemic therapy, including a BTK inhibitor. However, because liso-cel has been FDA approved in several indications, it’s essential to consider ways to navigate the 4-week mandate, she explained. Furthermore, it’s important to consider timing and the management strategies for CRS and ICANS, she continued. Developing a strategy for personally optimizing care post CAR T-cell infusion and patients remaining at academic centers for shorter amounts of time could improve access to care, Kamdar concluded.