Thread by @ChrisHeery

I completely understand this take. I respect those who feel this way, but I disagree that autologous CAR T should be the standard for allo CAR T. The standard should be other off the shelf therapeutics. Why? See thread.

https://twitter.com/bradloncar/status/1448019773242097667

Current allogeneic CAR Ts are being evaluated in the context of autologous CAR T already existing. So, at the centers where these studies are conducted, any patient who can get auto CAR T will. What does that lead to?

Selection bias. investopedia.com/terms/s/sample…

Allo CAR T studies are negatively biased toward the enrollment of patients who are most likely to have the worst outcomes by the prognostic indicators identified in autologous CAR T studies. Like which indicators?

Tumor burden
Rapid disease progression
Inability to produce autologous CAR T cells
Exhausted phenotype starting material

ashpublications.org/bloodadvances/…

Does this mean that autologous cells aren’t good? Not at all, they are great. Does it mean allogeneic cells have no role? No, they still appear to be as good or better than any other off the shelf agent to achieve deep response in a short time. So, could be a bridge or improve.

Durable responses were less common for auto CAR T in 2012. I think we will see improvements continue over time with allo. I don’t know if it will ever get to auto levels, but I think that is the wrong bar. Would like to hear from physicians. @MichaelDJain @NitinJainMD

One other thought here: we are living in an incredible age of medical technology. 20 years ago, this was all a dream. Now, we are quibbling over whether it is good to have 20+% of people who were on a path to a rapid death survive longer with better QoL.