Implications of Expanding Use of CAR T-Cell Therapy in Relapsed/Refractory Non-Hodgkin Lymphoma (NHL) - Episode 4

Optimizing CAR T in R/R NHL

Jeff Sharman, MD, comments on optimizing CAR T administration as a therapeutic option for disease progression in NHL and shares his thoughts on the TRANSCEND NHL 001 trial.


Jeff Sharman, MD: Regarding existing data sets that are out there, there are a handful of products that are approved or nearing approval for the management of patients with relapsed large-cell lymphoma. What we’re going to see is an expansion of indications; it won’t be only large-cell lymphoma but additional disease indications. We’ve seen some of these move into mantle cell. There’s interest in developing this in third-line follicular lymphoma. There are other products targeting multiple myeloma. This is a platform that’s going to be moving forward.

We’ve seen with CAR [chimeric antigen receptor] T, it’s important to understand this population. The majority of patients with relapsed large-cell lymphoma, if they’re not able to get to a cure with transplant, these are patients who are going to pass away quickly. Large-cell lymphoma oftentimes is a fast-moving malignancy. Oftentimes, they show up with relapsed disease in clinical extremis when they’re admitted to the hospital or dealing with complications already. We try to get their disease back under control. But if we can’t get them through transplant or they’ve gone through transplant and still have disease that’s relapsed, a large fraction of these patients are going to pass away from their disease and do so over the course of weeks or a handful of months.

The enthusiasm and excitement surrounding CAR T lies in this technology that’s able to get a number of these individuals into remission. The longer we follow these patients, the more impressive it becomes with regard to how long these remissions can stay. We are indeed curing a number of these individuals. I don’t know that the field is going to embrace that term wholeheartedly until the data are more mature, but we’re seeing that without further therapy, many of these patients are able to maintain prolonged disease control.

TRANSCEND-NHL-001, which is a study for the Juno [Therapeutics, Inc] product, looks encouraging. We see high levels of response and, particularly for those patients who get to a complete response, these responses can be very durable. Where many of the patients who experience a complete response are not experiencing downstream progression after that. All stated, this is an exciting technology, an exciting product, and we’re encouraged to see how this plays out in the clinical real world, even beyond the clinical trial setting.