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Optimizing Monitoring After CAR-T Therapy | Manali Kamdar, MD | #EHA2025
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• July 11, 2025
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Dr. Kamdar presents data from clinical trials and real-world studies showing that nearly all side effects from liso-cel occur within the first two weeks. These findings challenge the current four-week monitoring mandate and could reduce barriers to CAR T access for patients with lymphoma.

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Manali Kamdar, MD

Transcript
Hi, my name is Dr. Manali Kamdar. I'm an associate professor at the University of Colorado in the U.S. We are at EHA 2025 and I am delighted to present my abstract entitled, Infusion Monitoring Requirements After CAR T-cell Therapy. Can we optimize it? Just to give a background to our audience, CD19 CAR T-cell therapy has revolutionized how we treat our patients with relapsed refractory lymphomas. Patients who would have previously had no options are now able to get salvaged and live better with CAR T-cell therapy. However, CAR T-cell therapy has unique adverse events called cytokine release syndrome, CRS, or neurotoxicity called ICANs, which limits the ability to do CD19 CAR T-cell therapy in every community site. As a result, majority of the patients who get CAR T-cell therapy, they do this at a CAR T referral center. It could be a private practice program or an academic institution with CAR T ability. Currently, the regulatory bodies have mandated that patients have to be very close to the site where they get CAR T-cell therapy for at least four weeks in order to make sure that these unique adverse events called CRS and ICANs be tackled. Unfortunately, the four-week mandate certainly puts lots of barriers around logistical barriers, socioeconomic barriers, thus limiting access to CAR T-cell therapy. Lysocaptogen marilucil or lysocell is a CD19 CAR T-cell therapy that has excellent efficacy, excellent durability, as well as very low rates of CRS and ICANs. And currently, Lysocaptogen has been approved in patients with relapsed refractory large B-cell lymphoma, relapsed refractory mantle cell lymphoma, relapsed refractory follicular lymphoma, and relapsed refractory CLL. As the indications expand, we seek to address and answer the question, is this four-week monitoring absolutely required for every patient who undergoes Lysocaptogen marilucil as their CAR T-cell therapy for any of the currently approved indications? And with that in mind, we did a comprehensive analysis across five pivotal trials in relapsed refractory follicular, diffused large B-cell lymphoma, mantle cell lymphoma, and CLL, as well as looked at a real-world data from a registry study called the CIBMTR transplant registry study. In relapsed refractory diffused large B-cell lymphoma, we identified 1,500 patients who underwent Lysocaptogen marilucil CAR T-cell therapy for any of the indications. If you look at the clinical trial subsets versus the registry subset, about 700 patients were in each of these cohorts. Both of these cohorts were uniformly similar with regards to patients who were heavily pretreated or patients who needed bridging treatment. However, patients on the clinical trial set were younger and fitter, and patients on the registry set were slightly older and less fit. The idea behind understanding this was to understand when CRS or ICANS occur. So the net is that in the clinical trial set, CRS occurred in about 54% of patients, and 98% of patients who had CRS, this occurred within the first two weeks of getting CAR T-cell therapy. Majority of patients who had CRS were all low grade. Any CRS that happened after two weeks was very rare. In the clinical trial set, it was only seven patients, and none of them needed ICU-level care. When you look at the registry data, it was very similar. 50% of patients had CRS of any grade, majority of them had low grade, and all of these CRS events, 98% to be precise, happened in the first two weeks after receiving Lysocaptogen marilucil. Now let's pivot to understanding when did neurotoxicity happen. So on the clinical trial set, neurotoxicity happened in about 27% of patients. Majority of them were low grade, and about 88% of these events happened within the first two weeks after infusion. On the registry set, ICANS or neurotoxicity happened in 30% of patients, and again 98% of these happened within the first two weeks after infusion, and these were all low grade. Any patient who experienced delayed neurotoxicity, these were all managed without ICU-level care and completely resolved. So the net is that if you combine patients across these pivotal trials, as well as the registry data where patients received Lysocaptogen marilucil for relapse refractory lymphoma, 96% of patients developed any unique adverse events, namely CRS and ICANS, within the first two weeks of receiving Lysocaptogen. And thus this really calls to rethink the four-week mandate, and the idea would be that this data get presented to the regulatory bodies so as to be able to allow us to keep the patients for a shorter amount of time, thus decreasing the logistical burden, the socioeconomic burden that these patients often face alongside their lymphoma. Thank you very much. I hope this was helpful.

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