CAR-T Follow-Up

Well, ASH is over, and that means it's time for the press releases from researchers and analyses from experts about what mattered most. I'll keep an eye on it and report back on the good stuff.

One of the outcomes from ASH that has gotten some attention was the updated numbers on CAR-T therapy.

If you've been reading the blog for a while, you are familiar with CAR-T, or Chimeric Antigen Receptor T cell therapy. It's a very recent, very promising treatment that involves removing T cells (a kind of immune cell that usually attacks invaders) from a patient, changing them in a way that makes them recognize cancer cells as invaders, putting them back into the patient, and allowing them to do their job. CAR-T has shown some real promise for Follicular Lymphoma.

You can read more about CAR-T from two readers, Ben and Bill, who run the CAR-T and Follicular Non-Hodgkin's Lymphoma blog. Bill sent me a couple of emails with links (thanks, Bill) -- for a presentation at ASH, and a publication in the New England Journal of Medicine, with updated data on CAR-T treatments in lymphoma, including Follicular Lymphoma. (Ben is a CAR-T patient, as is Bill's wife.)

The NEJM article looks at 111 patients with "refractory large B-cell lymphoma after the failure of conventional therapy." Basically, they haven't been able to get a response with the things they have tried. And that group of large B-cell Lymphoma patients includes patients with Transformed Follicular Lymphoma.

Of the 111 patients, 110 were able to have T cells changed, and 101 of them were able to have them administered.

The Overall Response Rate was 82%, with a Complete Response of 54%. With a Median Follow-Up of 15.4 months, 42% of patients who had a response continued to have one, and 40% of patients who had a Complete Response continued to have one.


Out of this larger group, 16 patients had Transformed Follicular Lymphoma. They were analyzed as part of a slightly larger group of 24 patients (the rest had another type of Lymphoma). In that group of 24, 20 of them had a Response (17 had a Complete Response), and 2 more had Stable Disease.

One of the concerns about CAR-T treatments are the side effects, which can be especially harsh. In the NEJM study, every patient had at least one adverse event. These included neurologic problems and Cytokine Release Syndrome, though they seemed to be controlled, and the treatments to control the symptoms did not seem to have an impact on the treatment. (I get the sense that CAR-T researchers are better prepared for these problems, though I don't want to downplay how serious they are.)

The most important thing to come out of the study is the treatment's durability -- it lasts a while. People who had a response right away continue to have a response.

It seems like CAR-T treatments remain as promising as we had hoped (so far). It will be interesting to see the next long-term follow-up to see if the responses remain as durable as they have been.