Dr Patel on Second Primary Cancer Prevention Strategies After CAR T-Cell Therapy

“One of the components of secondary prevention is identifying patients who have an inherent baseline risk or predisposition to developing SPCs. Another major aspect of secondary prevention includes identifying patients who may have baseline inflammation or comorbidities that might place them at higher risk for developing SPCs.”

Shyam A. Patel, MD, PhD, associate professor, Department of Medicine, UMass Chan Medical School; hematologist/oncologist, UMass Memorial Medical Center, discusses potential secondary prevention strategies for monitoring and mitigating the risk of developing second primary cancers (SPCs) in patients with hematologic malignancies after treatment with CAR T-cell therapy.

Secondary prevention strategies play a critical role in mitigating several of the risks associated with CAR T-cell therapy, particularly the development of SPCs, Patel begins. One of the key secondary prevention strategies is identifying patients who have an inherent baseline risk or predisposition for developing SPCs, he states. This includes patients with pre-existing clonal hematopoiesis, a condition in which a subpopulation of blood cells displays somatic mutations within the hematopoietic compartment, causing a clonal expansion of these mutated cells, Patel details.

These mutations can predispose patients to clonal expansion of the mutated cells, potentially leading to the development of malignancies, especially in the post–CAR T-cell therapy setting, Patel explains. Given this increased risk, it may be prudent to screen patients for baseline clonal hematopoiesis prior to initiating CAR T-cell therapy, he says. However, despite its potential value, there is currently no consensus in the guidelines regarding this approach for secondary SPC prevention, Patel notes.

In addition to clonal hematopoiesis, another significant component of secondary prevention involves identifying patients with baseline inflammation or comorbidities that may elevate their risk of developing SPCs following treatment with CAR T-cell therapy, Patel continues. Overall, secondary prevention efforts should focus on stratifying patients based on their baseline risk factors, including clonal hematopoiesis and other comorbidities, Patel concludes.