Matthew Cortese, MD, MPH

The final portion of the program shifts to case-based discussion, with the panel applying earlier debates to real-world clinical scenarios in relapsed/refractory DLBCL. The first case, a fit 58-year-old with early relapse, prompts consensus around rapid movement to CAR-T therapy with bridging strategies such as polatuzumab-based regimens, whereas the second case highlights challenges related to primary refractory disease and inconsistent caregiver support. The program concludes with closing remarks and a debate winner announcement, reinforcing the collaborative nature of evolving treatment strategies in LBCL.

The teams debate whether CAR-T or bispecific antibodies should be prioritized as the treatment paradigm evolves in relapsed large B-cell lymphoma, with Team NYC centering the argument on “cure” and the curative-intent potential/plateau of CAR-T outcomes. Team Roswell agrees cure is the goal but argues that real-world access barriers and “off-the-shelf” availability make bispecifics, and especially emerging combination strategies, crucial for patients who cannot reliably reach or complete CAR-T. The discussion highlights a key tradeoff: CAR T as a one-time, time-limited intervention vs bispecifics requiring ongoing dosing and infrastructure, with durability, infection risk, and sequencing still actively evolving.

The panel debates how real-world differences in efficacy, vein-to-vein time, manufacturing reliability, and toxicity should influence selection between the two second-line CAR T options for early relapsed/refractory LBCL. One side argues that efficacy is broadly similar and that lower all-grade CRS/neurotoxicity, especially for outpatient delivery, favors the less toxic product, whereas the other emphasizes faster manufacturing, longer follow-up experience, and the importance of overall survival data in driving decisions. The discussion converges on individualized selection based on the patient in front of you (disease tempo, fitness, logistics, and center capacity), while acknowledging the lack of head-to-head randomized comparisons.

Panelists engage in a structured debate on whether CAR T-cell therapy for aggressive large B-cell lymphoma should be administered in the inpatient or outpatient setting. Team NYC argues for inpatient treatment in higher-risk or socially complex cases, citing logistical barriers, caregiver limitations, and the need to manage serious toxicities such as CRS and ICANS. Team Roswell counters that outpatient programs can safely expand access, reduce hospital-related complications, and improve patient acceptance of CAR T, prompting a broader discussion on evolving safety data, real-world logistics, and changing regulatory requirements.

Team Roswell presents ABC Consortium real-world data from 15 US centers comparing second-line outcomes with axi-cel, liso-cel, and a third CAR T product in large B-cell lymphoma, including manufacturing timelines, bridging therapy, response, survival, and key toxicities. The discussion highlights faster vein-to-vein time and fewer out-of-spec products with axi-cel, broadly similar efficacy between axi-cel and liso-cel, and higher rates of cytokine release syndrome/neurotoxicity with axi-cel alongside lower acute toxicity with liso-cel. Team NYC cross-examines the interpretation, especially the limited sample for the third product, and the panel pivots to practical post–CAR T survivorship issues like infections, hypogammaglobulinemia, IVIg use, and the need for more standardized supportive-care practices.

Team Roswell presents ABC Consortium real-world data from 15 US centers comparing second-line outcomes with axi-cel, liso-cel, and a third CAR T product in large B-cell lymphoma, including manufacturing timelines, bridging therapy, response, survival, and key toxicities. The discussion highlights faster vein-to-vein time and fewer out-of-spec products with axi-cel, broadly similar efficacy between axi-cel and liso-cel, and higher rates of cytokine release syndrome/neurotoxicity with axi-cel alongside lower acute toxicity with liso-cel. Team NYC cross-examines the interpretation, especially the limited sample for the third product, and the panel pivots to practical post–CAR T survivorship issues like infections, hypogammaglobulinemia, IVIg use, and the need for more standardized supportive-care practices.

Teams from Roswell Park and New York City discuss advances in CAR T-cell therapy for large B-cell lymphoma. Team Roswell presents real-world data comparing second-line CAR T therapy with standard salvage chemotherapy and transplant approaches, highlighting improved event-free and overall survival outcomes with CAR T. Team NYC challenges the findings, raising questions about patient selection, treatment bias, and how real-world data should be interpreted alongside randomized clinical trial results.