PMID- 38030311 OWN - NLM STAT- MEDLINE DCOM- 20231201 LR - 20231217 IS - 2352-3026 (Electronic) IS - 2352-3026 (Linking) VI - 10 IP - 12 DP - 2023 Dec TI - CD19-directed CAR T cells as first salvage therapy for large B-cell lymphoma: towards a rational approach. PG - e1006-e1015 LID - S2352-3026(23)00307-1 [pii] LID - 10.1016/S2352-3026(23)00307-1 [doi] AB - The approval of CD19-directed chimeric antigen receptor (CAR) T-cell therapies for the second-line treatment of high-risk large B-cell lymphoma (LBCL) has greatly affected salvage algorithms for this condition, and such therapies could have the potential to improve the course of relapsed or refractory LBCL. In this Review, we provide guidance for a rational management approach to the use of commercial CD19-directed CAR T cells in the second-line treatment of LBCL, addressing crucial questions regarding eligible histologies; age, comorbidity, and tumour biology restrictions; the handling of very aggressive tumour behaviour; and holding and bridging therapies. The guidance was developed in a structured manner and, for each question, consists of a description of the clinical issue, a summary of the evidence, the rationale for a practical management approach, and recommendations. These recommendations could help to decide on the optimal management of patients with relapsed or refractory LBCL who are considered for second-line CAR T-cell treatment. CI - Copyright (c) 2023 Elsevier Ltd. All rights reserved. FAU - Dreger, Peter AU - Dreger P AD - Department of Medicine V, University of Heidelberg, Heidelberg, Germany. Electronic address: peter.dreger@med.uni-heidelberg.de. FAU - Corradini, Paolo AU - Corradini P AD - Division of Hematology, IRCCS Istituto Nazionale dei Tumori Milano, University of Milano, Milan, Italy. FAU - Gribben, John G AU - Gribben JG AD - Centre for Haemato-Oncology, Barts Cancer Institute, Queen Mary University of London, London, UK. FAU - Glass, Bertram AU - Glass B AD - Department of Hematology and Cell Therapy, Helios Klinikum Berlin-Buch, Berlin, Germany. FAU - Jerkeman, Mats AU - Jerkeman M AD - Department of Oncology, Skane University Hospital, Lund, Sweden. FAU - Kersten, Marie Jose AU - Kersten MJ AD - Department of Hematology, Amsterdam UMC, location AMC, Cancer Center Amsterdam and LYMMCARE, Amsterdam, Netherlands. FAU - Morschhauser, Franck AU - Morschhauser F AD - Hematology Department, CHU Lille, Universite de Lille, ULR 7365, Groupe de Recherche sur les formes Injectables et les Technologies Associees, Lille, France. FAU - Mussetti, Alberto AU - Mussetti A AD - Hematology Department, Institut Catala d'Oncologia - Hospitalet, Institut d'Investigacio Biomedique de Bellvitge, Universitat de Barcelona, Barcelona, Spain. FAU - Viardot, Andreas AU - Viardot A AD - Department of Internal Medicine III, Ulm University Hospital, Ulm, Germany. FAU - Zinzani, Pier Luigi AU - Zinzani PL AD - IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seragnoli", Bologna, Italy; Dipartimento di Scienze Mediche e Chirurgiche, Universita di Bologna, Bologna, Italy. FAU - Sureda, Anna AU - Sureda A AD - Hematology Department, Institut Catala d'Oncologia - Hospitalet, Institut d'Investigacio Biomedique de Bellvitge, Universitat de Barcelona, Barcelona, Spain. CN - European Society for Blood and Marrow Transplantation and the European Hematology Association Lymphoma Group LA - eng PT - Journal Article PT - Review PL - England TA - Lancet Haematol JT - The Lancet. Haematology JID - 101643584 RN - 0 (Receptors, Antigen, T-Cell) RN - 0 (Antigens, CD19) SB - IM MH - Humans MH - *Receptors, Antigen, T-Cell/therapeutic use MH - Salvage Therapy MH - *Lymphoma, Large B-Cell, Diffuse/drug therapy MH - T-Lymphocytes MH - Immunotherapy, Adoptive MH - Antigens, CD19 COIS- Declaration of interests PC reports consultancy for BMS, Celgene, Gilead Sciences, Janssen Pharmaceuticals, Novartis, Sanofi, and BeiGene; participation on speakers' bureaus for BMS, Gilead Sciences, and Novartis; and travel grants from Janssen Pharmaceuticals, Roche, Gilead Sciences, and Novartis. PD reports consultancy for AbbVie, AstraZeneca, BeiGene, BMS, Gilead Sciences, Miltenyi Biotec, Novartis, and Riemser; participation on speakers' bureaus for AbbVie, AstraZeneca, BeiGene, BMS, Gilead Sciences, Novartis, Riemser, and Roche; and research support from Riemser, all to his institution. BG reports consultancy for BMS and Roche and research funding from Riemser. JGG reports consultancy for AbbVie, Amgen, AstraZeneca, BMS/Celgene, Janssen Pharmaceuticals, Kite Gilead, and Novartis; and research funding from AstraZeneca, BMS/Celgene, and Janssen Pharmaceuticals. MJ reports consultancy for AbbVie, AstraZeneca, Autolus, Genmab, Gilead Sciences, Janssen Pharmaceuticals, Novartis, Pierre Fabre, and Roche; and research support from AbbVie, AstraZeneca, Gilead Sciences, Janssen Pharmaceuticals, and Roche. MJK reports honoraria from BMS/Celgene, Kite/Gilead, Novartis, and Roche; consulting or advisory roles for BMS/Celgene, Kite Gilead, Miltenyi Biotec, Novartis, Takeda Pharmaceuticals, and Adicet Bio; and research funding from Kite Gilead, all to her institution. FM reports consulting fees from Roche, Gilead Sciences, Novartis, BMS, AbbVie, Genmab, Miltenyi Biotec, Allogene Therapeutics, AstraZeneca, and Janssen Pharmaceuticals. AM reports consultancy for BMS, Jazz Pharmaceuticals, Merck, and Takeda Pharmaceuticals; and research funding from Kite Gilead. AS reports consultancy for BMS, Celgene, Gilead Sciences, Janssen Pharmaceuticals, MSD, Novartis, Sanofi, and Takeda Pharmaceuticals; participation on speakers' bureaus for BMS, MSD, and Takeda Pharmaceuticals; and travel grants from BMS, Celgene, Janssen Pharmaceuticals, Roche, Sanofi, and Takeda Pharmaceuticals. AV reports consultancy for AbbVie, Gilead Sciences, Novartis, BMS, Roche, and Amgen; honoraria from Roche, Gilead Sciences, BMS, and AbbVie; and travel grants from Roche, Gilead Sciences, and AbbVie. PLZ reports consultancy for ADC Therapeutics, AstraZeneca, BeiGene, BMS, Celltrion, EUSA Pharma, Incyte Kyowa Kirin, Novartis, Gilead Sciences, MSD, Roche, Sandoz, Secura Bio, Servier Laboratories, and Takeda Pharmaceuticals; and participation on speakers' bureaus for AstraZeneca, BeiGene, BMS, Celltrion, EUSA Pharma, Incyte Kyowa Kirin, Novartis, Gilead Sciences, MSD, Roche, Servier Laboratories, and Takeda Pharmaceuticals. EDAT- 2023/11/30 00:42 MHDA- 2023/12/01 06:44 CRDT- 2023/11/29 20:56 PHST- 2023/04/21 00:00 [received] PHST- 2023/09/09 00:00 [revised] PHST- 2023/10/06 00:00 [accepted] PHST- 2023/12/01 06:44 [medline] PHST- 2023/11/30 00:42 [pubmed] PHST- 2023/11/29 20:56 [entrez] AID - S2352-3026(23)00307-1 [pii] AID - 10.1016/S2352-3026(23)00307-1 [doi] PST - ppublish SO - Lancet Haematol. 2023 Dec;10(12):e1006-e1015. doi: 10.1016/S2352-3026(23)00307-1.