Improving Patient Access to CAR T-Cell Therapy

A recent study examined the real-world experience of patients receiving CD19-directed chimeric antigen receptor (CAR) T-cell therapies for B-cell non-Hodgkin lymphoma. The primary focus was on the occurrence and duration of side effects like cytokine release syndrome (CRS) and immune effector cell-associated neurotoxicity syndrome (ICANS).

The results showed that while the incidence and duration of these adverse effects varied between different CAR T products, most severe reactions occurred within the first 2 weeks after infusion. Importantly, new-onset CRS was extremely rare after 2 weeks, and only 1 case of new-onset ICANS was reported in the third week. These findings have significant implications for patients who have difficulty accessing CAR T due to practical or financial constraints due to the follow-up time required after the treatment.

The study also analyzed the causes of nonrelapse mortality, finding that ICANS was a significant factor in the early period, while infections were more common later on. These findings suggest that a shorter monitoring period might be possible for many patients, potentially reducing the financial burden and inconvenience associated with prolonged hospital stays.

Here, Nausheen Ahmed, MD, associate professor of hematologic malignancies and cellular therapeutics at the University of Kansas Medical Center, discusses issues with access to CAR T-cell therapy that the study explored.

Transcription:

0:05 | A lot of patients are not able to get CAR T because because they don't have ability to stay for weeks. They don't have maybe the ability to have a caregiver for four weeks. There's there's some nuances there. So this is hopefully, if there's a change made based on these findings, this might help many patients.

0:27 | I do think that in general, the closer that CAR T can be to an off the shelf medication, the less the physical burden, the less the financial burden, right, on the patient. That, in general, will increase the utilization of CAR T. So for example, there's a whole process where they have to come get get evaluation get what we call leukapheresis. They get collection done and waiting processes for 2 weeks. And so I wonder if some of those processes can be streamlined, which would be more on the scientific end, or where if we have allogeneic products, which are off-the-shelf products that might make it easier. If we have products with even more safety profile where the monitoring period could be even even more amenable where the patients can go back to the community earlier. Those are things I'm looking forward to.