Considering Age/Comorbidities in CAR T-Cell Therapy Consultation for LBCL
There is no absolute age cutoff where CAR T cells are contraindicated for those with large B-cell lymphoma, says David L. Porter, MD.
Patients with large B-cell lymphoma (LBCL) should be evaluated for CAR T-cell therapy regardless of age or comorbidities, according to David L. Porter, MD.
Porter, the director of Cell Therapy and Transplant at the University of Pennsylvania School of Medicine, spoke with CancerNetwork® during the 2024 Transplantation and Cellular Therapy Meetings about how clinicians should approach CAR T-cell therapy consultation for patients with LBCL.
In a community oncologist roundtable that convened to determine an appropriate framework for referring patients with LBCL for CAR T-cell therapy, Porter and his colleagues coined the slogan “If they RECUR, you should refer” to summarize their approach for treating this population. According to Porter, the “E” of RECUR stands for “every age and comorbidity,” reflecting the stance that no specific age or condition should preclude patients from receiving CAR T-cell therapy.
Transcript:
One of the points of the roundtable was whether the decisions about age and comorbidity should be left up to the care team with expertise in administering CAR T-cell therapies. We believe that, too often, a decision is made early. Before a formal evaluation—say a patient may be too old for this, or "Gosh, they may be too sick"—it may be made prematurely in a setting where the people making that decision may not have the expertise for this therapy.
The "E" in RECUR stood for "every age and comorbidity. "Patients should be referred. There is not an absolute age cutoff where CAR T cells are contraindicated. There may be some comorbidities that preclude CAR T cells, but we really felt that needed to be addressed by the care team with expertise in administering CAR T-cell therapy. [In fact], every patient with relapsed/refractory lymphoma should be referred almost regardless of age and comorbidity; leave it up to the care team with expertise to make that decision. There may be clinical trials trying to minimize toxicity, so something that a year ago we thought would preclude treatment because of a comorbidity may not be the case anymore. We were very careful not to be prescriptive about age and comorbidity and think these patients should be evaluated.
Reference
Riedell PA, Downs C, Boehmer L, Ebmeier J, Porter D, Williams A. If They RECUR, you should refer: a community oncologist patient ID roundtable summary. Transplantation and Cellular Therapy. 2024;30(1):14-16. doi:10.1016/j.jtct.2023.10.019
