Update on CAR T-Cell Therapy and Approval Criteria Changes
Recent updates regarding CAR T-cell therapy include details on patient referrals, treatments, and changes to approval criteria. The information highlights patient outcomes, referral processes, and criteria updates for various types of lymphomas. It also discusses the importance of monitoring and adjusting treatment plans for high-risk patients undergoing therapy. Explore the latest developments in CAR T-cell therapy and approval criteria modifications for better patient outcomes.
- CAR T-cell therapy
- lymphoma treatment
- patient referrals
- approval criteria changes
- high-risk patients
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Presentation Transcript
CAR T Update 23/02/2023
Service Dr Stephen Robinson- Lead for IEC Dr Sanne Lugthart NCCP member Dr Caroline Besley NCCP member, Consultant IEC (currently on maternity leave) Dr Rajesh Alajangi Locum consultant covering Dr Besley's maternity leave Dr Dilupa Gunasekhara Associate specialist CNS- Olivia Lamb Pharmacy- Brijesh Gautama, Nicole Morrow Jenny Le, Abigail Pocock, Jo Mayo- IEC co-ordinators Plans for ANP in CAR T cell therapy
Data 1186 applications presented so far to NCCP Bristol- 2021 Number of referrals for DLBCL/PMBCL/MCL 45 Number proceeded to leukapheresis 38 Number proceeded to CAR T infusion 25
2021 13 patients did not proceed to CAR T infusion. 11 of them had apheresis. Two of these patients did not proceed to infusion due to the following reasons 1 patient had hip fracture 1 patient's diagnosis was reversed to B ALL hence CAR T therapy was stopped 2 patients did not proceed with apheresis -1 patient had declined CAR T therapy -1 patient had progressive disease prior to apheresis.
2022 Number of referrals for DLBCL 38 7 patients not approved by panel Number proceeded to apheresis 25 Number proceeded to CAR T infusion 20 Number of referrals for MCL 6 1- not eligible, 5 approved Number proceeded to apheresis 2 Both failed manufacture 1 apheresed again, successful manufacture Number proceeded to CAR T infusion 1
Changes to approval criteria Progressive disease now can be demonstrated using RECIST criteria and Lugano Criteria (PET) EBV negative, EBV positive PTLD now approved for CAR T cell therapy DLBCL with CNS involvement at first diagnosis, treated with systemic therapy (MARIETTA protocol) followed by stem cell transplantation as part of first line therapy and subsequently relapsed/refractory.
MCL- High-risk patients starting ibrutinib should have CT re- staging within 8 12 weeks (earlier if concern). Lack of early response with stable/progressive disease on ibrutinib should prompt an urgent referral to a CAR T-cell centre
Other updates Myeloma BCMA CAR s to start ? June this year CAR T 2nd line still under review
Challenges Delays in getting Apheresis slots, manufacture slots Disease progression- bridging therapies Treatments for relapsed patients Expansion of CAR T service
