Modern management of relapsed and refractory aggressive B-cell lymphoma: A perspective on the current treatment landscape and patient selection for CAR T-cell therapy

Approximately 65% of patients with diffuse large B-cell lymphoma are cured with first-line therapy. However, approximately 10% to 15% exhibit primary refractory disease, and 20% to 25% experience relapse after initial response. Eligible patients receive second-line therapy followed by high-dose chemotherapy and an autologous hematopoietic stem cell transplant, previously the only potentially curative option for this population. Recently approved chimeric antigen receptor (CAR) T-cell therapies offer an alternative curative option for patients who have experienced a second-line or later relapse or whose disease is refractory. CD19-targeting CAR T cells are autologous T cells expressing an anti-CD19 CAR that, when reintroduced to the patient, identify and kill CD19⁺ B cells. Because of the novelty of CAR T-cell therapy and the complexity of this patient population, identification of ideal candidates is still being defined. This article summarizes 3 patient cases, focusing on the important aspects of patient selection for CAR T-cell therapy.