Blood Cancers Today (BCT)Long-Term Outcomes of CAR T-Cell Therapy in Patients With CLL

This long-term follow-up analysis of 31 patients with relapsed/refractory CLL demonstrates sustained remissions following CD19-directed CAR T-cell therapy, with median follow-up extending to 9.1 years in the monotherapy cohort. The study provides critical evidence for potential curative outcomes in a historically poor-prognosis patient population.

⚕️ Key Clinical Considerations ⚕️

• Complete response correlation: Patients achieving complete response within one year showed significantly superior progression-free survival (P=.014) and overall survival (P=.046) compared to partial responders.
• Sustained remission rates: Among one-year responders, 77.4% remained progression-free at last follow-up, with 19 patients maintaining remission beyond five years.
• Ibrutinib discontinuation feasibility: In combination therapy patients, 64.7% successfully discontinued ibrutinib while maintaining clinical remission, with 91% remaining disease-free.
• Durable five-year outcomes: Progression-free survival rates of 57.1% (monotherapy) and 64.7% (combination) demonstrate long-term efficacy in heavily pretreated patients.
• Treatment selection impact: No significant survival difference between monotherapy and ibrutinib combination approaches suggests flexibility in treatment planning.

🎯 Clinical Practice Impact 🎯

• Patient Communication: Counsel patients that CAR T-cell therapy offers potential for long-term remission or cure in relapsed/refractory CLL, with approximately three-quarters of one-year responders maintaining disease control long-term.
• Practice Integration: Establish protocols for identifying optimal CAR T-cell candidates, emphasizing complete response as a critical prognostic marker for sustained benefit.
• Risk Management: Implement extended surveillance protocols for CAR T-cell recipients, particularly monitoring for late effects while recognizing the potential for treatment-free intervals.
• Action Items: Develop patient selection criteria prioritizing those likely to achieve complete response, and create ibrutinib discontinuation algorithms for combination therapy recipients in sustained remission.

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