Addressing the importance of lymphodepletion, factors contributing to ICAHT & the cost effectiveness of CAR-T therapy
Feb 29, 2024
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Exploring the importance of lymphodepletion in CAR-T therapy, addressing factors contributing to ICAHT, and discussing the cost effectiveness of CAR-T treatment. Insights from experts on personalized dosing, toxicity reduction, and financial implications of these agents.
Lymphodepletion is vital for preparing the body and tumor for CAR-T infusion.
ICAHT pathogenesis involves patient factors and personalized treatment strategies.
Deep dives
Importance of Lympho Depletion in CAR-T Cell Cycle
Lympho depletion is a crucial component of the CAR-T cell cycle, preparing the body, immune system, microenvironment, and tumor for the infusion of CAR-T cells. Research highlighted the lack of scientific basis for different regimens used, leading to an emphasis on personalizing doses to balance efficacy and toxicity. Contributions from colleagues like Sloan Kettering in devising pharmacokinetic indexes aim to improve dose accuracy, though challenges persist in predicting actual thresholds for individual patients.
Understanding and Predicting ICAT in CAR-T Therapy
The pathogenesis of ICAT involves factors such as the patient's hematopoietic stem cell reserve, local bone marrow conditions, CRS-induced changes in inflammatory mediators, and emerging evidence on clonal expansion phenomena. The CAR-Himatatox score, incorporating pre- and post-infusional factors, helps predict hematological toxicity risk and guide personalized treatment strategies. Ongoing research efforts focus on preclinical modeling and computational approaches to grade ICAT and identify clinical risk predictors.
Cost Effectiveness of CAR-T Therapy
Studies on the cost effectiveness of CAR-T therapy show varying results influenced by factors like patient demographics and long-term benefits uncertainty. While cost effectiveness ratios range from 40,000 to 250,000 euros per quality, models indicate substantial benefits in terms of saving lives and improving quality of life. The one-time treatment nature of CAR-T therapy justifies higher prices compared to long-term interventions, aligning with typical oncology drug cost ranges.
Although CAR-T cells have revolutionized the treatment of hematological malignancies, there are several important factors that must be addressed regarding the use of these agents. One ongoing challenge is the prevention and management of CAR-T-related toxicities, including immune effector cell-associated hematotoxicity (ICAHT), as well as how to improve affordability and access to these agents.
In this podcast, you will hear from Ulrich Jäger, MD, Medical University of Vienna, Vienna, Austria, who discusses the importance of lymphodepletion in CAR-T therapy, Kai Rejeski, MD, Memorial Sloan Kettering Cancer Center, New York, NY, who updates us on ICAHT, and Gérard de Pouvourville, PhD, ESSEC Business School, Cergy, France, who shares his thoughts on the cost effectiveness of these agents.