The Fellow on Call: The Heme/Onc Podcast Episode 139: Follicular Lymphoma Series, Pt 4 - Relapsed/Refractory Management (Cellular therapy options)
Sep 17, 2025
Dive into the latest advancements in treating relapsed/refractory follicular lymphoma with a focus on cellular therapies like CAR T and bispecific antibodies. Discover how these therapies are manufactured and administered, plus insights into patient selection criteria. Learn about the distinct effects of cytokine release syndrome and neurotoxicity, along with detailed trial results and safety profiles. The conversation also highlights practical considerations for clinicians and the real-world application of these cutting-edge treatments.
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Always Repeat Biopsy Before Changing Therapy
- Always re-biopsy the most avid lesion in relapsed follicular lymphoma to exclude large-cell transformation.
- Prefer excisional biopsy; use core biopsy only if surgical access is limited.
How CAR T Works
- CAR T modifies a patient’s T-cell receptor to target a chosen antigen and trigger killing without co-stimulation.
- The engineered T cells self-expand after infusion and act as a living, one-time drug.
Bispecifics Are Molecular Matchmakers
- Bispecific antibodies bridge CD3 on T cells to CD20 on B cells, bringing them into proximity to trigger cytotoxicity.
- These are off-the-shelf drugs given with step-up dosing and can be fixed-duration or continuous depending on the agent.