Dr. Nastoupil on Logistical Considerations for CAR T-Cell Therapy in DLBCL

Loretta J. Nastoupil, MD, a medical oncologist in the Department of Lymphoma/Myeloma, of the Division of Cancer Medicine, at The University of Texas MD Anderson Cancer Center, discusses logistical considerations for CAR T-cell therapy in patients with diffuse large B-cell lymphoma (DLBCL).

CAR T-cell therapy presents logistical challenges, as the majority of patients require a referral to receive this modality, says Nastoupil. The majority of centers that offer treatment with axicabtagene ciloleucel (Yescarta) and tisagenlecleucel (Kymriah) are traditionally transplant centers, adds Nastoupil.

The novel CAR T-cell product lisocabtagene maraleucel (liso-cel; JCAR017; Celgene) may offer a potential advantage over other options because of its favorable safety profile, which may make it well suited for administration in outpatient centers, according to Nastoupil. That raises the question of whether a designated transplant center is necessary for administering CAR T-cell therapy, says Nastoupil.

Several other nuances need to be taken into account with this approach, Nastoupil adds. Although this therapy can be administered safely in an outpatient setting, approximately 60% of patients who receive liso-cel will require hospitalized due to fever or cytokine release syndrome. If outpatient or community practices are interested in administering this therapy, they will need to establish an affiliation with a hospital to appropriately manage admissions. They must also train staff to recognize symptoms of cytokine release syndrome or neurotoxicity, advises Nastoupil.

These considerations have led to discourse that is necessary to extend the benefit of liso-cel to as many patients as possible, according to Nastoupil. Having community providers offer the treatment is a critical step in the process; however, it's important to establish partnerships with institutions that have the knowledge necessary to assist community practices in navigating these unique situations, Nastoupil concludes.