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Sep 30
Education

EDU 43 - The Fast CAR Race: Where Does Radiotherapy Place? Challenging Cases in the Cellular Therapy Era

12:45pm - 02:00pm PT
Hematologic Malignancies

MODERATOR(S)

Chirayu Patel, MD, MD, MPH - MGH

Michael Yunes, MD - Baystate Medical Center

session DESCRIPTION

A session of four challenging cases in lymphoma and myeloma with a panel of expert radiation oncologists, including one in private practice, and a medical oncologist is proposed: 1. Urgent need for debulking in extramedullary relapse of multiple myeloma after BCMA-targeted CAR T-cell therapy. Treatment/timeline will be summarized up to point of CAR T-cell therapy. Radiotherapy plans will be detailed along with systemic therapy options. The case will feature several extramedullary relapses, showcasing how urgent radiotherapy allowed bridging to novel systemic therapies. 2. Consolidative radiotherapy for rel/ref large B-cell lymphoma after CAR T-cell therapy - newer data suggesting the utility of consolidative radiotherapy in patients with partial response or stable disease based on day 30 PET/CT will be summarized. A case with limited sites of disease treated with consolidative radiotherapy will be discussed. 3. Refractory CNS lymphoma - who completed bridging radiotherapy to CAR T-cell therapy. The patient case will be detailed with MRI. Discussion will focus on WBRT vs. focal RT, and dose/fractionation, with considerations to long-term outcomes with PFS and neurocognitive sequelae of RT. The available data on RT as a bridging strategy will be summarized. 4. Bridging RT prior to CAR T in a patient with rapidly progressive refractory high-grade B cell lymphoma with plans for CAR T-cell therapy. Discussion will focus on options for bridging radiotherapy, including pros/cons of adaptive radiotherapy, and the range of dose/fractionation/field size. Non-conventional approaches will be reviewed as well as what to do with a very compressed timeline to CAR T.

learning objectives

  1. Explain the factors that may influence radiation technique, dose, fractionation, and field size in the bridging, consolidation, and salvage radiation for CAR T-cell therapy for lymphoma and multiple myeloma.
  2. Critically evaluate imaging for patients after CAR T-cell therapy, and decide if patient should be considered for consolidative radiotherapy, and to what sites.
  3. Balance the goals and toxicity of bridging radiation therapy in patients with refractory CNS lymphoma undergoing CAR T cell therapy.

Credits

AMA PRA Category 1 Credits: 1.25

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