Timely Referral and Bridging Therapy in Large B-Cell Lymphoma

Dr. Melody revisits Mr. R's treatment course after his local oncologist refers him to a regional cell therapy center, highlighting the importance of coordinating treatment for a patient with aggressive, symptomatic large B-cell lymphoma who lives 90 minutes away. Dr. Perales emphasizes that early referral and close collaboration between community oncologists and cell therapy specialists are essential to allow sufficient time for evaluation and treatment planning. He distinguishes between holding therapy, which is used before apheresis to control disease and symptoms, and bridging therapy, which is administered after apheresis and before CAR T-cell infusion. Dr. Perales explains that these approaches are often combined in real-world practice and may include systemic therapy or radiation depending on the patient's disease status and response. He notes that pivotal trials used more restrictive approaches to bridging therapy, whereas real-world practice frequently incorporates active disease control between referral, collection, and infusion. The discussion reinforces the value of early referral and coordinated care throughout the CAR T-cell treatment process for patients with large B-cell lymphoma.