Many Lymphoma Patients Missing Out on Best Care
For patients with relapsed diffuse large B-cell lymphoma, survival often depends on more than the disease itself. It hinges on whether they receive the right treatment at the right place. A study presented at the American Society of Hematology annual meeting shows that patients who pursue guideline-recommended therapies, such as chimeric antigen receptor T-cell (CAR T) therapy, live longer. Experts say the best chance of accessing those treatments is at academic cancer centers that specialize in advanced care.
Gaps in Guideline-Based Care
A significant gap in treatment is leaving many people with relapsed or refractory diffuse large B-cell lymphoma without the therapies most likely to extend their lives. National guidelines recommend CAR T-cell therapy for most eligible patients, yet data show that as many as 75% never receive it. Instead, many are directed to less effective options, resulting in thousands of avoidable deaths and shortened survival.
Dr. Frederick Locke
The study projected that among the roughly 8,399 CAR T-eligible patients who relapse each year in the United States, up to 6,299 could be misallocated to nonguideline-concordant therapies. That misallocation was linked to an estimated 783 additional deaths within five years. Even at lower misallocation rates of 15%, the analysis found 157 excess deaths.
“In our analysis, following treatment guidelines could improve five-year survival by up to 15% and add about two years to a patient’s life,” said Frederick Locke, MD, lead study author and chair of the Blood and Marrow Transplant and Cellular Immunotherapy Department at Moffitt Cancer Center. “That’s not just a statistic. For families, those are birthdays and life moments regained.”
What Makes CAR T Different
CAR T-cell therapy is not a drug but a living treatment. Doctors collect the T cells, which are part of the immune system, and reengineer them so they can target and destroy lymphoma cells. These reprogrammed cells are then infused back into the patient, where they go on the attack.
Clinical studies and real-world evidence confirm that for many with tough-to-treat diffuse large B-cell lymphoma, CAR T offers the best shot at lasting remission or even a cure. Five-year survival rates for CAR T patients managed according to guidelines reached as high as 57%, compared to 42% for those who did not. That survival gap translates to an average loss of 25 months of life expectancy for patients who miss out, highlighting the stakes of treatment decisions.
The Role of Advocacy
Locke says the findings point to a larger issue in cancer care. Patients may not always be offered the full range of therapies for which they qualify. Eligibility criteria can be complex, and treatment guidelines evolve rapidly, creating gaps between what is recommended and what occurs in practice.
"Patients should be aware that CAR T is an option for many who relapse early, and they should feel empowered to ask about it,” Locke said. “Our study shows that when patients receive the therapies outlined in guidelines, survival improves.”
