Dr Neelapu on Streamlining the Delivery of CAR T-Cell Therapy in Lymphoma

Sattva S. Neelapu, MD, deputy department chair, professor, Department of Lymphoma/Myeloma, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, discusses processes that have been adopted by treating oncologists and institutions that are used to streamline the delivery of CAR T-cell therapy to patients with lymphoma.

Neelapu begins by saying that CAR T-cell therapy is administered at specialized CAR T centers, with over 125 such facilities across the United States. He reports that each institution is staffed by specially trained personnel. Tisagenlecleucel (tisa-cel; Kymriah), which was initially approved by the FDA in 2017 for the treatment of pediatric and young adult patients with acute lymphoblastic leukemia, was the first CAR T-cell therapy to gain FDA approval for the treatment of any disease. Since then, many institutions, including MD Anderson, have developed their own CAR T-cell therapy administration protocols, Neelapu adds.

At MD Anderson, a nurse coordinator is involved in the CAR T-cell therapy process from the moment a patient is identified as eligible for CAR T-cell therapy, guiding them through the treatment, he continues. The nurse coordinator ensures insurance approval is obtained once a patient is identified for this therapy, according to Neelapu. Following insurance approval, the patient is scheduled for leukapheresis, Neelapu explains. Coordination with the referring physician or the patient’s primary oncologist determines the necessary bridging therapy, as patients often have rapidly progressing disease, he says. Approximately 50% of patients require bridging therapy to stabilize their disease during the CAR T-cell therapy manufacturing process, Neelapu adds.

The manufacturing turnaround time ranges from 2 to 4 weeks, depending on the manufacturer, he expands. After the product is ready, the patient returns to the CAR T center and typically receives lymphodepleting chemotherapy as an outpatient procedure. Patients who are treated with axicabtagene ciloleucel (Yescarta) receive inpatient care, Neelapu says. When receiving CAR T products such as tisa-cel and lisocabtagene maraleucel (Breyanzi), which are associated with fewer toxicities, patients have the option to receive treatment as either an outpatient or inpatient procedure, based on their preference, he concludes.