Present and future approaches with CAR T cell therapy in B-cell malignancies - meeting organised and funded by BMS
In his welcome and introduction Paolo Corradini, MD University of Milan Milan, Italy stressed the following points:
• This symposium is a scientific presentation and discussion for the purpose of scientific exchange. Neither the symposium nor the information presented or discussed is for the promotional purpose of influencing prescribing or treatment decisions.
• This symposium may include information about investigational products and/or uses that are not approved for use in any country or in the country of your residence.
• Prescribing decisions are made by healthcare professionals. Always refer to the approved product labeling of the country where you practice before prescribing (e.g. Sm PC, US Prescribing Information).
The Educational Objectives of the symposium
• Understand the increasing role of chimeric antigen receptor (CAR) T cell therapy in B-cell malignancies including diffuse large B-cell lymphoma (DLBCL), follicular lymphoma (FL) and chronic lymphocytic leukaemia (CLL).
• Comprehend the clinical efficacy and safety data advances of CART cells in DLBCL, FL, and CLL and how this therapy is expected to shape the current treatment landscapes.
• Discuss the strategies and the practical considerations for the optimal implementation of CART cell therapy in clinical practice. In addition, to gain a better understanding into the future direction of the use of CART cell therapy in the management of patients with B-cell malignancies.
Program
Prof. Paolo Corradini, Chair of Hematology, University of Milan, Italy:
The current state of CAR-T cell therapy in OLBCL
Lectures agenda:
1. Unmet medical need and outcome results in clinical trials: - tisagenlecleucel (tisa-cel), axicabtagene ciloleucel (axi-cel), lisocabtagene maraleucel (liso-cel)
2. Real-world setting data
3. Brief overview of practical consideration in the implementation of CART cell therapy - patient selection; bridging chemo/radiotherapy; cytopenias and infections
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Guillaume Cartron, Head of Hematology Department, University Hospital Center, Montpellier, France:
CART cell therapy in Fl and Cll: achievements and perspectives
Lectures agenda:
1. CART in FL - Main results & toxicities: ZUMA-5. Axi-Cel; ELARA/Tisa-Cel; CTL-019. Tisa-Cel
2. CART in CLL - Main results: Univ Pen. CDl 9 TCR-l;/4.1 BB; TRANSCEND-CLL: Liso-Cel monotherapy; T-cell dysfunctions in CLL; lbrutinib role; TRANSCEND-CLL: Liso-Cel with ibrutinib; TRANSCEN D-CLL. Liso-Cel with/without lbrutinib; Fred Hutch. CDl 9 TCR-l;/4.1 BB with/without ibrutinib
CART-cell therapy in FL and CLL
Achievements
• CAR T-cells provide a very high CRR and durable response for FL patients, without serious toxicity
• CART-cell results for CLL patients are preliminary, and more studies are needed
• Addition of lbrutinib needs further investigations
Perspectives
• A randomized study should include POD24 and third line of treatment or higher patients
• Larger study with lbrutinib or other strategies (allogeneic CAR T-cells or CAR NK cells) would hove more clinical value
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Stephan Mielke, Professor for Hematology & Cellular therapy, Karolinska Institute, Stockholm, Sweden:
Implementation of CART cell therapy: practical considerations and future directions
The burning questions coming from the real world ...
• Is CART-cell therapy a definitive therapy? Plateau in ZUMA-l & JULIET. Maybe yes for responding DLBCL
• Is CART-cell therapy a bridge to transplant? As shown, it works as a bridge in ALL, but do we need it?
• Can we predict the success of the therapy when we start? low tumor burden, low LOH are beneficial
• Can we herald the relapse? B-cell reappearance, MRO, and CART cell monitoring are tools. However, no evidence yet
• How do we deal with the relapse? We have options for C019 +/- relapse!
• Can allogeneic SCT play a role after relapse after CAR T-cell therapy? Yes I
How do we really implement CART-cells in the treatment pathway of different diseases (ALL, DLBCL, etc.)?
WE DO NOT KNOW (YET)!
We need more real-life information on all CAR-T cell therapies!
- Expanding the EBMli registry to capture data on LTFU of Patients treated with CAR-T cells and other types of IEC or HSC Medicinal Products
- Sweden's CART-cell competence network (SWECARNET)
EBMT-EHA CART recommendations currently being prepared Goal of journal submission in May 2021