Tara M. Graff, DO, MS

Panelists review a patient with DLBCL relapsing 8 months after frontline Pola-R-CHP following an initial complete response. With low symptom burden and favorable performance status, the debate centers on optimal second-line strategy, outpatient CAR T feasibility, caregiver limitations, and balancing treatment intensity with quality-of-life and employment considerations in an urban setting.

Faculty analyze a primary refractory, high-intermediate–risk DLBCL case with persistent PET-positive disease after frontline R-CHOP and symptomatic progression. Discussion focuses referral for second-line CAR T and how rural geography and distance from a CAR-T center influence logistics. Panelists weigh aggressive disease biology against access barriers and caregiver availability in determining next steps.

Panelists debate whether the treatment paradigm in relapsed/refractory LBCL has fundamentally shifted from salvage chemotherapy and autologous transplant toward novel immune-based strategies. The discussion centers on CAR T-cell therapy versus bispecific antibodies, examining differences in outcomes. Faculty explore how emerging data, sequencing considerations, and real-world constraints are redefining treatment decision-making.

Panelists debate how to select between axicabtagene ciloleucel and lisocabtagene maraleucel for patients with rapidly progressive second-line DLBCL. Key arguments examine differences in efficacy signals, vein-to-vein time, and toxicity profiles and how these factors influence urgency of treatment. Faculty explore how real-world experience, institutional infrastructure, and patient-specific risk factors and lifestyle shape optimal CAR T product selection.

Panelists debate whether high-risk disease biology should accelerate referral for CAR T-cell therapy in second-line DLBCL. Key arguments consider patient-specific sequencing approaches, emphasizing individualized assessments before committing to CAR T. The opposing argument supports early referral for CAR T in biologically high-risk patients. Faculty weigh the balance between urgency and personalization, exploring how disease kinetics, logistical barriers, and real-world practice patterns influence optimal timing of referral.

Panelists discuss real-world data from the US ABC Consortium evaluating axicabtagene ciloleucel, tisagenlecleucel, and lisocabtagene maraleucel in relapsed/refractory LBCL. Faculty discuss key differences in manufacturing, review outcomes, and consider toxicity profiles for each of the CAR T products in clinical practice.

Panelists analyze comparative real-world data from the French DESCAR-T registry evaluating axicabtagene ciloleucel and lisocabtagene maraleucel in second-line relapsed/refractory LBCL. Faculty consider distinctions in toxicity profiles along with selection bias, vein-to-vein time, patient frailty, and whether certain patients may preferentially benefit from one CAR T product over another in routine second-line practice.

Panelists examine real-world comparative data from the French DESCAR-T registry and REALYSA cohort evaluating second-line axicabtagene ciloleucel versus standard-of-care salvage therapy in early relapsed/refractory DLBCL. The discussion highlights the event-free survival with CAR T-cell therapy (1-year EFS 46% vs 16% in SOC). Faculty also discuss the impact of third-line CAR T use in the SOC arm and what these real-world registry data mean for routine second-line treatment decision-making.

Tara M. Graff, DO, MS, stated that combination therapy approaches may be the optimal route forward for advancing MZL care.

“…if [there’s] a younger patient with MZL, I’m willing to risk a little extra toxicity to give them a longer-term remission,” said Tara M. Graff, DO, MS.

Subcutaneous mosunetuzumab achieved consistent rates of complete responses across various high-risk marginal zone lymphoma subgroups.

The subcutaneous formulation of mosunetuzumab will require 17 cycles of therapy, without any maintenance, and can be done in outpatient settings.