Why CAR T Isn’t a Simple “Cure” for CLL: Kerry Rogers, MD

Patients with chronic lymphocytic leukemia (CLL) are increasingly asking their oncologists about chimeric antigen receptor (CAR) T-cell therapy after seeing headlines calling it “curative.” According to Kerry Rogers, MD, associate professor at The James—The Ohio State University Comprehensive Cancer Center, that word carries more nuance than most news coverage conveys.

Rogers says the excitement is understandable, but it often outpaces patient understanding of what the therapy actually involves and who benefits most. Some patients with CLL that has never required treatment ask whether they could get CAR T-cell therapy just to be rid of the disease for good. She described a familiar exchange: patients tell her, “I like you, but I have things to do,” when she explains the realities of the treatment, and ultimately decide, “I think we’ll just keep on observing your CLL,” which sounds better to them once the tradeoffs are clear.

Even when CAR T-cell therapy works, Rogers noted, patients still need ongoing disease monitoring and may face B cell defects for the rest of their lives. She also fields frequent questions about why the therapy isn’t used earlier or in other cancers. In CLL, CAR T-cell therapy has mainly been reserved for patients who’ve grown resistant to targeted agents, since oral therapies already offer good quality of life and health span for many. Younger patients with high-risk disease, however, might benefit from earlier use, potentially limiting years of exposure to costly Bruton tyrosine kinase (BTK) inhibitors, which can run over $20,000 a month.

Success rates are another misunderstood piece. Rogers noted the original trial of lisocabtagene maraleucel (liso-cel; Breyanzi; Bristol-Myers Squibb), the approved CAR T-cell product in CLL, showed roughly a 20% complete remission rate—the group most likely to see durable benefit—although newer data using BTK inhibitors for disease control beforehand appear to be pushing that rate higher.

Ultimately, Rogers said, gaps between emerging clinical data and public perception remain a real barrier: “misinformation or lag in what the real outcomes are” continues to complicate how patients understand their options.