Improved Patient Outcomes With CAR T as an Early Line of Treatment

Lynch discusses the critical importance of early referral for CAR T therapy, highlighting several factors that contribute to improved outcomes. The fitness and function of T cells significantly impact treatment success, making earlier referral beneficial before multiple lines of therapy compromise T-cell quality. Studies like ZUMA-7 and TRANSFORM have demonstrated survival benefits for patients receiving CAR T in earlier treatment lines.

The manufacturing process requires weeks to months, making timing crucial for patients with aggressive disease kinetics. Early referral allows treatment centers to optimize patient conditions, address medical comorbidities, and arrange necessary social support systems while cells are being manufactured. The ability to cryopreserve cells provides flexibility for patients who need time to optimize their health status before infusion.

Lynch emphasizes that patients requiring bridging therapy typically have worse outcomes, partly due to aggressive disease biology but also potentially due to certain bridging agents. Japanese data suggests bendamustine within 3 months of CAR T collection may increase manufacturing failure rates. She advocates for early referral even when CAR T need is uncertain, as this allows parallel optimization of patient conditions and treatment preparation. Manufacturing failure represents a particularly devastating outcome since patients never receive the opportunity to try CAR T therapy.