How Allogeneic and In Vivo CAR T Could Expand Access

Autologous chimeric antigen receptor (CAR) T-cell therapy has transformed the treatment of several hematologic malignancies, but its complex manufacturing process and infrastructure requirements can limit where it can be delivered. In an interview with Targeted Oncology, Krish Patel, MD, executive director of hematologic cancer research at Sarah Cannon Research Institute, discusses how allogeneic and in vivo CAR T-cell approaches could potentially make cellular therapy more accessible across different care settings.

Autologous CAR T requires leukapheresis to collect a patient’s immune cells, followed by manufacturing, shipping, and storage of the engineered product before it can be administered. These requirements can create logistical and infrastructure barriers, particularly outside specialized treatment centers.

Allogeneic, or “off-the-shelf,” CAR T approaches aim to address some of these challenges by using T cells from a healthy donor rather than collecting cells from the patient. Patel discusses the potential advantages of eliminating the need for patient leukapheresis, as well as the challenges of engineering donor-derived cells to prevent complications such as graft-vs-host disease. Advances in gene-editing technology could help further develop these platforms.

The field is also exploring an even more streamlined approach: in vivo CAR T-cell therapy. Rather than collecting cells from either a patient or donor, these therapies aim to deliver a vector directly into the patient to generate CAR T cells inside the body.

Although both approaches remain early in development, Patel notes that they could ultimately reduce the infrastructure needed to deliver cellular therapies. If allogeneic or in vivo CAR T platforms can demonstrate safety, efficacy, and durability comparable with autologous CAR T, they could expand access to cellular therapy beyond highly specialized treatment centers and into a broader range of care settings.