CAR T-cell Therapy in Indolent Lymphoma

Abstract

Introduction CD19 directed chimeric antigen receptor (CAR) T-cell therapy has had a transformative impact on the natural history of chemotherapy refractory aggressive B-cell non-Hodgkin lymphoma (B-NHL) and B-cell acute lymphoblastic leukemia (B-ALL), inducing long-term remissions in 40–50% of patients.1–5 It does this, however, at the expense of both financial and clinical toxicity. But the cost and risk of care in the absence of CAR T-cells in these instances outweighs the risk of the therapy itself, and so it has broadly been accepted as a standard of care for these patients. Moving CD19 directed CAR T-cell therapy into the slower growing, but historically incurable, indolent B-NHLs has the potential to challenge this balance between risks and benefits. Will CAR T-cells offer definitive therapy for these otherwise incurable diseases? If not, will CAR T-cells positively affect long-term survival over alternative therapies? The answer to these questions will determine how oncologists weigh the financial and clinical costs against the therapeutic benefits.