Preparing for CAR T cell therapy: patient selection, bridging therapies and lymphodepletion

Chimeric antigen receptor (CAR) T cells have emerged as a potent therapeutic approach for patients with certain haematological cancers, with multiple CART cell products currently approved by the FDA for those with relapsed and/or refractory B cell malignancies. However, in order to derive the desired level of effectiveness, patients need to successfully receive the CART cell infusion in a timely fashion. This process entails apheresis of the patient's T cells, followed by CART cell manufacture. While awaiting infusion at an authorized treatment centre, patients may receive interim disease-directed therapy. Most patients will also receive a course of pre-CART cell lymphodepletion, which has emerged as an important factor in enabling durable responses. The time between apheresis and CART cell infusion is often not a simple journey, with each milestone being a critical step that can have important downstream consequences for the ability to receive the infusion and the strength of clinical responses. In this Review, we provide a summary of the many considerations for preparing patients with B cell non-Hodgkin lymphoma or acute lymphoblastic leukaemia for CART cell therapy, and outline current limitations and areas for future research.

Automated summary

Chimeric antigen receptor (CAR) T cell therapy is an effective treatment for certain hematological cancers. Successful CAR-T cell infusion requires timely preparation and consideration of various factors. This review provides a summary of the considerations in preparing patients for CAR-T cell therapy and highlights current limitations and future research areas.