Liso-Cel in Relapsed DLBCL: Patient Selection, Outcomes, and Referral Strategies
Key Points
- Lisocabtagene maraleucel (liso-cel), an anti-CD19 chimeric antigen receptor (CAR) T-cell therapy, is a preferred treatment option for aggressive relapsed diffuse large B-cell lymphoma (DLBCL).
- Community oncologists should refer eligible patients to academic CAR T-cell centers early, emphasize the strong survival benefit seen in clinical trials, and encourage patients to overcome logistical barriers for at least a consultation.
CAR T-cell therapy continues to reshape the treatment landscape for B-cell lymphomas, offering durable responses and improved outcomes for patients with relapsed or refractory disease. At the 2026 American Society of Clinical Oncology Annual Meeting, Joshua Brody, MD, of the Icahn School of Medicine at Mount Sinai spoke with OncUpdates about the evolving role of liso-cel in this setting, including key considerations for patient selection and referral for CAR T-cell therapy.
The most common use case for liso-cel is relapsed DLBCL, particularly for rapidly relapsing patients, which is typically defined as relapse within 12 months of frontline therapy, said Dr. Brody. Data from phase 3 trials like TRANSFORM and ZUMA-7 show that liso-cel and other anti-CD19 CAR T-cell therapies offer an overall survival (OS) or significant improvement in progression-free survival benefit for this population. Liso-cel is still effective for non-rapidly relapsing DLBCL or DLBCL in later-line settings, and it is also approved for patients with mantle cell lymphoma or low-grade lymphomas.
The process of selecting patients for CAR T-cell therapy has become easier as CAR T-cell administration and toxicity management has been refined. The incidence of notable side effects like high-grade cytokine release syndrome (CRS) and neurotoxicity varies between agents, but has fallen to single digits with liso-cel, making it one of the preferred agents for vulnerable patients. When balancing efficacy, quality of life, and treatment logistics, efficacy becomes a focus for patients with aggressive disease, including relapsed DLBCL. Liso-cel and other CAR T-cell options match this impetus well, although there is a range of competitive options including bispecific antibody combinations.
Referring patients to academic centers for CAR T is crucial, although community oncologists may need to take extra steps to identify optimal patients to refer amidst all the different diseases treated in the community setting. Community oncologists may also need to advocate for CAR T-cell therapy if patients are concerned with traveling to referral centers to initiate and receive treatment. In these cases, Dr. Brody recommended that community oncologists emphasize the OS benefits described in trials and encourage patients to at least consult at the referral center before defaulting to other therapies.