CAR T Patient Eligibility for B-Cell Lymphoma

The discussion addresses patient eligibility criteria for CAR T therapy, with particular focus on older, frail patients commonly seen in community practice settings. Dr Friedman raises concerns about determining appropriate candidates, especially given the different patient demographics between community centers and academic medical centers.

Dr Jacobson provides comprehensive guidance on CAR T indications, including approvals for diffuse large B-cell lymphoma (second and third line), follicular lymphoma (third line and beyond), mantle cell lymphoma (after BTK inhibitor and/or chemo-immunotherapy), and chronic lymphocytic leukemia (after BTK inhibitors and BCL2 inhibitors like venetoclax). She emphasizes that eligibility criteria have evolved significantly since 2017, with treatment centers now accepting patients with various comorbidities previously considered contraindications.

The key message is that community oncologists should not attempt to determine CAR T candidacy independently. Instead, all patients meeting disease indications should be referred to CAR T treatment centers for evaluation. Dana-Farber has successfully treated patients on dialysis, those with cardiac dysfunction, autoimmune diseases, and patients requiring anticoagulation. Dr Jacobson shares an inspiring case of a 90-year-old woman who achieved excellent outcomes, reinforcing that age alone should not preclude referral for CAR T evaluation.