Early CAR T-Cell Referral in Relapsed/Refractory CLL

Dr. Jennifer J. Huang and Dr. Mazyar Shadman discuss referral patterns and challenges associated with chimeric antigen receptor (CAR) T-cell therapy for patients with relapsed/refractory chronic lymphocytic leukemia (CLL). Dr. Huang notes that many patients referred for CAR T-cell therapy have received multiple prior treatments and may be refractory to both Bruton tyrosine kinase (BTK) inhibitors and B-cell lymphoma 2 (BCL-2) inhibitors. Maintaining disease control while preparing for CAR T-cell therapy can be challenging, particularly when patients are progressing on their current treatment. The experts emphasize the importance of distinguishing between patients who have been exposed to a treatment class and those whose disease is refractory to it. They discuss the value of referring patients for CAR T-cell evaluation while an available therapy, such as pirtobrutinib, is still controlling the disease, rather than waiting until progression or exhaustion of treatment options. Dr. Shadman also highlights the importance of considering clinical trial availability without relying on investigational therapies as the sole basis for treatment planning.