Breaking Barriers: Next Steps in CAR T and Unmet Needs in R/R LBCL

There are several key areas where improvements are needed to optimize chimeric antigen receptor (CAR) T-cell therapy for patients. Firstly the current treatment process is often complicated and burdensome, requiring patients to relocate to another city for an extended period. While recent efforts have begun to streamline these requirements, more progress is necessary to make the process more patient-friendly. Another challenge involves delays caused by insurance approvals and other administrative hurdles, which can postpone timely treatment. Addressing these delays would significantly improve the patient experience and outcomes.

Importantly, CAR T therapy is not curative for everyone; roughly 40% to 50% of patients may need additional treatments later. This highlights the ongoing need to develop new therapies that can either cure those who don’t respond to CAR T or serve as effective consolidations to boost response rates closer to 100%. Safety concerns also remain, particularly long-term immune system complications. Questions about optimal timing and frequency of vaccinations, management of low immunoglobulin levels, and monitoring for persistent cytopenias are still unresolved. These issues matter because some patients who achieve remission after CAR T may still succumb to infections. Improved long-term follow-up clinics and stronger partnerships between treatment centers and local oncologists could help monitor and support patients more effectively.

Another emerging concern is the development of second malignancies, especially myeloid neoplasms, after CAR T therapy. It remains unclear whether these arise because patients live longer after lymphoma treatment or due to the biological effects of CAR T on bone marrow. Understanding and addressing this risk will require further research. On the regulatory front, recent updates easing some patient travel restrictions and monitoring requirements show that agencies are listening and responsive to patient needs. These changes allow more flexibility for centers to tailor care, potentially enabling patients to return home sooner while maintaining safety and quality. Strengthening collaborations between treatment centers and local providers will be key to supporting this shift.