DR LOVE: Can you provide a little bit of an overview of what we know about the efficacy of CAR T therapy right now in lymphomas, including diffuse large B-cell?

DR NASTOUPIL: Right. So the efficacy appears to be quite high. So in general, we’re thinking about something that is truly worth pursuing. We’re looking for efficacy with a response rate over 30% in relapsed large cell lymphoma. We’re seeing efficacy above 60%, and we’re also seeing complete response rates above 50%, which is quite striking. So this is an all-or-none type of approach where we’re really shooting for a complete response. And we do believe those complete responses to be durable.

Where we’ve seen problems is — so patients have their first response assessment, generally, on study at day 30, which is quite early. There have been a few patients that have had a partial response that then convert to a complete response. But probably more likely, those who have a partial response will ultimately end up progressing. So that’s your first glimpse of how likely or how effective this will be.

Now, again, there are differences in terms of the CAR Ts in terms of their characteristics, in regards to their activating signals. There are also differences in terms of how we infuse the CAR Ts that are being looked into. There are newer generations of CAR Ts where you can dial down the toxicity with either an off-signal or a sleeper cell that you can inactivate the CAR Ts. So there are lots of different technologies that are currently being explored. But the efficacy appears to be quite high.

I think what we’re trying to work out is the toxicity and whether or not this will be something that can be done at many centers across the United States, because it’s still requiring a high level of care and essentially 24-hour supervision of these patients, which is not something that’s entirely feasible at every community hospital.

DR LOVE: Usually for how long is intensive support like that required?

DR NASTOUPIL: It’s a little bit unpredictable. So on average, it’s anywhere from 4 to 7 days, where the acuity can be quite high. But again, some of the neurotoxicity, though not requiring a high level of care such as ICU care, but can actually be prolonged, up to 30 days.

Non-Hodgkin lymphoma (NHL), Hodgkin lymphoma and chronic lymphocytic leukemia (CLL)

Acute and chronic leukemias and myeloproliferative neoplasms

Multiple myeloma (MM)