The Role of ASCT After CAR T-Cell Therapy

Robert J. Soiffer, MD, the chair, Executive Committee for Clinical Programs, vice chair, Department of Medical Oncology, chief, Division of Hematologic Malignancies, and institute physician at Dana Farber Cancer Institute, discusses how the role of transplantation is evolving with the availability of chimeric antigen receptor (CAR) T-cell agents.

According to Soiffer, who is also the Worthington and Margaret Collette Professor of Medicine in the Field of Hematologic Oncology, Harvard Medical School, transplantation has been done within patients for close to 40 years and consists of 2 types: autologous and allogeneic transplantation. A number of approved therapies for diseases like non-Hodgkin lymphoma, Hodgkin lymphoma and multiple myeloma exists, but there is a need to further understand how to best use them and in what context.

In regard to transplantation in the evolving post CAR T setting, CAR T cells are commonly used for patients who had an autologous transplant and for who may have had other therapies prior. However, the question of whether CAR T-cell therapy could actually replace one of these transplants remains.

0:08 | We're not at the beginning of the end, we are at the end of the beginning of a CAR T-cell therapy. It has taken 20 plus years for CAR T cells to evolve to the point where we have therapies that are approved. We still need to figure out how to use them, in what context to use them, whether they're going to be used adjunctively with auto transplant, to follow auto transplant, whether they're going to replace transplant altogether, or whether they're going to be used in other settings.

0:48 | I think what we'll be seeing in the next 5 years are more and more studies trying to evaluate the use of CAR T-cell therapy in a variety of different diseases. It is an extraordinarily exciting time and fast changing. I believe if we have this conversation in a year or 2, it will be a different discussion.