How I treat refractory/relapsed diffuse large B‐cell lymphomas with CD19‐directed chimeric antigen receptor T cells

Abstract

SummaryChimeric antigen receptor (CAR) T cells targeting CD19 represent a promising salvage immunotherapy for relapsed/refractory diffuse large B‐cell lymphoma (R/R DLBCL), offering ~40% of long‐term responses. In everyday clinical practice, haematologists involved in CAR T cell treatment of patients with R/R DLBCL have to deal with diagnostically complex cases and difficult therapeutic choices. The availability of novel immunotherapeutic agents for R/R DLBCL and recent advances in understanding CAR T‐cell failure mechanisms demand a rational approach to identify the best choice for bridging therapy and managing post‐CAR T‐cell therapy relapses. Moreover, positron emission tomography/computerised tomography may result in false‐positive interpretation, highlighting the importance of post‐treatment biopsy. In this review, we discuss all above issues, presenting four instructive cases, with the aim to provide criteria and new perspectives for CAR T‐cell treatment of DLBCL.