Decentrale CAR-T-celltherapie haalbaar en effectief bij terugkerend groot-B-cel-lymfoom

CD19 chimeric antigen receptor (CAR) T cell therapy has transformed outcomes for patients with relapsed/refractory (R/R) large B cell lymphoma (LBCL), yet access to commercial products remains severely limited in low- and middle-income countries due to high cost, infrastructure requirements, and centralized manufacturing. Herein, we developed and implemented a decentralized point-of-care (POC) CAR T cell platform in Thailand using an automated closed system (CliniMACS Prodigy), integrating local manufacturing with clinical delivery. Between 2020 and 2025, 12 patients with R/R LBCL (median age 45.8 years) were treated, with a median vein-to-vein time of 12 days. Manufacturing was successful in 11 patients, while one received an out-of-specification dose. Final products demonstrated a balanced CD4:CD8 ratio and were enriched for memory T cell subsets. Cytokine release syndrome occurred in 5 patients (grade 3 in 1), and neurotoxicity in 1 patient (grade 1). At 3 months, the overall response rate was 58.3%, including 33.3% complete responses. One-year event-free and overall survival were 58.3% and 90%. The median total cost was USD 111,231. These findings demonstrate that decentralized POC CAR T cell therapy is feasible, effective, and more affordable, supporting scalable implementation in resource-limited settings.