Table 1. Suggested discussion framework... | American Society of Hematology

Table 1.

Suggested discussion framework regarding SPMs after CAR T therapy

Discussion point	Supporting evidence
The benefits of CAR T therapy generally outweigh the risks	CAR T therapy has been shown to extend PFS, OS, and QOL compared with traditional therapies in several cancers. CAR T therapy offers a “one-and-done” treatment for patients with the potential for rapid and durable remissions.
A causal association is possible but many confounders exist	Many other factors, including prior alkylating chemotherapy and immortal time bias, need to be examined carefully. The presence of neoplastic CAR⁺ T cells does not itself prove that the CAR “caused” the malignancy.
Patients’ active cancers are often a bigger threat than a hypothetical cancer years later	Even in patients who develop SPMs, their original malignancy can remain a cause of death. T-cell malignancies are heterogenous, and some (e.g., T-LGL) may have excellent prognoses even if they occur.

Discussion point	Supporting evidence
The benefits of CAR T therapy generally outweigh the risks	CAR T therapy has been shown to extend PFS, OS, and QOL compared with traditional therapies in several cancers. CAR T therapy offers a “one-and-done” treatment for patients with the potential for rapid and durable remissions.
A causal association is possible but many confounders exist	Many other factors, including prior alkylating chemotherapy and immortal time bias, need to be examined carefully. The presence of neoplastic CAR⁺ T cells does not itself prove that the CAR “caused” the malignancy.
Patients’ active cancers are often a bigger threat than a hypothetical cancer years later	Even in patients who develop SPMs, their original malignancy can remain a cause of death. T-cell malignancies are heterogenous, and some (e.g., T-LGL) may have excellent prognoses even if they occur.

OS, overall survival; PFS, progression-free survival; QOL, quality of life; SPM, second primary malignancy; T-LGL, T-cell large granular lymphocytic leukemia.