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Relapsed Follicular Lymphoma CAR-T — RACP Adult Medicine MCQ

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HardHaematologyRelapsed Follicular Lymphoma CAR-TRACP Adult Medicine

A 70-year-old woman with stage IV follicular lymphoma progresses on R-CHOP and R-bendamustine. She has relapsed twice. She undergoes PET-CT showing widespread FDG-avid disease. What is the recommended treatment for multiply relapsed follicular lymphoma?

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Correct answer: DCAR T-cell therapy (axicabtagene ciloleucel or tisagenlecleucel)

For multiply relapsed/refractory follicular lymphoma (after ≥2 prior lines of therapy), anti-CD19 CAR T-cell therapy (axicabtagene ciloleucel – approved based on ZUMA-5 trial; tisagenlecleucel – based on ELARA trial) is now available and offers durable responses in 60–80% of patients. It is TGA-approved and PBS-listed in Australia for this indication. Lenalidomide + rituximab (AUGMENT trial) and PI3K inhibitors are alternatives. Bispecific antibodies (mosunetuzumab – LOTIS-2 trial) are also emerging as effective options. Allogeneic SCT offers potential cure but carries significant transplant-related mortality.

Reference: eTG – 2025 – Haematology; PBS – 2025 – CAR T-cell Therapy Listings