CAR-T cell therapy clinical trials provide more hope for lymphoma and leukaemia patients

Dr Michael Dickinson is the Lead of the Aggressive Lymphoma disease group within Clinical Haematology at Peter MacCallum Cancer Centre and Royal Melbourne Hospital. Michael has been instrumental in treating patients with chimeric antigen receptor T (CAR-T) cell therapy nationally. As Snowdome supported Michael for several years as the Peter MacCallum Cancer Centre Clinician Researcher Fellow and the Julie Borschmann Research Fellow, we took the opportunity to interview Michael to learn more about the future of CAR-T cell therapy for lymphoma and leukaemia.

To date, Michael has treated approximately 50 patients with CAR-T cell therapy and has seen some remarkable recoveries during that time. While CAR-T might not be a cure for everyone it can be life changing for others. Clinicians are still trying to determine who will respond to treatment, when in the treatment pathway should CAR-T cell therapy be introduced, and which subtypes of lymphoma and leukaemia can it effectively treat. To answer these questions a number of clinical trials are underway at the Peter MacCallum Cancer Centre. If any of these trials are relevant to you, please speak with your haematologist.

Mantle Cell Lymphoma
Michael is particularly excited and proud of the trial he has designed for patients with mantle cell lymphoma. The centre is recruiting patients with relapsed or refractory mantle cell lymphoma (MCL) or up-front in those who have had a sub-optimal response to standard therapy in the presence of TP53 mutation. In a world first trial, patients receive a combination of CAR-T cell therapy and ibrutinib. It is hoped that the combination and earlier introduction of CAR-T cell therapy will provide patients with improved outcomes. The trial is open at Peter Mac now and is opening at other cities around the country in coming months.

Diffuse Large B-cell Lymphoma
For patients with diffuse large B-cell lymphoma (DLBCL) who relapse and are candidates for a stem cell transplant, a trial is being conducted to determine whether CAR-T cell therapy or stem cell transplant provides patients with a better outcome. This trial is one of the first to introduce CAR-T cell therapy earlier in the treatment pathway and is currently recruiting patients in multiple centres around the country, with Peter Mac the only site in Melbourne

Double-hit Lymphoma
Double-hit lymphoma is notoriously difficult to treat and sadly has a poor prognosis.
A trial is underway to examine the effects of CAR-T cell therapy earlier in the treatment pathway. Following two rounds of chemotherapy patients automatically receive CAR-T cell therapy if PET scans detect disease presence. This trial is currently recruiting patients.

Other B-cell Lymphomas
Clinical trials exploring CD19 CAR-T cells in other B-cell lymphomas such as chronic lymphocytic leukaemia (CLL) and acute lymphoblastic leukaemia (ALL) are also currently recruiting.

Other blood cancers
The role of CAR-T cell therapy in other forms of blood cancer such as myeloma are also underway. It is important to ask your haematologist if you are interested in participating in clinical trials to access new treatments earlier. Sadly, less than 20% of Australian blood cancer patients access clinical trials despite evidence to support better outcomes when treated as part of a clinical trial.