Sending Patients to Referral Centers for CAR T and Bispecific Antibody Treatment Decisions for B-Cell Lymphoma

Dr Friedman outlines his referral process for CAR T therapy, describing different patient pathways including direct community referrals and shared care arrangements with Dana-Farber. His practice involves straightforward referrals for patients who progress during or shortly after first-line therapy, with established communication systems, including electronic referrals and nurse navigator coordination, making the process seamless.

The discussion addresses the evolving treatment landscape for large-cell lymphoma, particularly with the introduction of bispecific antibodies. Dr Friedman expresses his preference for CAR T therapy based on its established track record and curative potential, noting that while bispecific combinations may be promising, CAR T has the longest follow-up data demonstrating durable responses. For patients who strongly prefer to avoid CAR T, bispecific plus chemotherapy combinations can be initiated in Boston with subsequent community-based continuation after step-up dosing.

The collaborative approach between community and academic centers allows for individualized treatment decisions. While community oncologists may have treatment preferences, final decisions often involve consultation with lymphoma specialists who can discuss all options with patients. This shared decision-making process ensures patients receive comprehensive counseling about available treatments while respecting both medical expertise and patient preferences regarding treatment location and intensity.