# Referral and eligibility assessment for CAR T-cell therapy

Source: https://onco.cc/protocols/car-t-referral-and-eligibility/  
OnCo record `car-t-referral-and-eligibility` (Protocol). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

CAR T-cell therapy is given at specialist centres, and a team there decides. For large B-cell lymphoma that does not respond to first treatment or returns within a year, CAR T cells are now the standard next step, so early referral matters. The centre checks your fitness, heart, brain and blood, and you will need to stay near the hospital, with someone to help, for at least two weeks after.

## Summary

EBMT 2025 indications (Table 1, adults; category/evidence level as printed): in large B-cell lymphoma, CAR T cells are standard of care (S/I) for primary refractory disease, early relapse with untested or chemoresistant disease and early chemosensitive relapse, where axicabtagene ciloleucel or lisocabtagene maraleucel beat salvage chemotherapy and autologous transplant in two phase III trials; for late relapse autologous transplant remains standard (S/II) and CAR T a clinical option (CO/II); after a failed autograft CAR T is standard (S/II). Follicular lymphoma: CAR T within the EMA labels, standard for refractory relapse (S/II). Mantle cell lymphoma: not first line outside trials; a clinical option second line after primary BTK inhibitor failure. Myeloma: idecabtagene vicleucel and ciltacabtagene autoleucel within their labels. Primary CNS lymphoma relapse: clinical option. Hodgkin lymphoma: not convincingly better than other options to date.

EBMT/JACIE 2019: the decision is made by a multidisciplinary team in a designated centre; cumulative chemotherapy harms T-cell quality, so plan collection early. SITC 2020: prior allogeneic transplant, BiTE or antibody therapy is no bar if the target antigen is expressed (LE: 4); weigh ECOG performance status; recent or active intracranial haemorrhage excludes (LE: 4); refer for neurological review if there is inflammatory neurological disease or CNS involvement; baseline CRP, ferritin, LDH, blood count, chemistry and echocardiogram or MUGA (LE: 4). FDA 2025: the REMS ended; labels now ask patients to stay near a healthcare facility for at least two weeks and not to drive for two weeks.

## Fields

- Kind: Protocol
- Last checked: 2026-11-11
- Also known as: CAR-T referral; CAR T eligibility; CAR-T candidacy; who can have CAR T; CAR-T indications
- Tags: protocol; cell-therapy; car-t

## Connected records

- protocols: [Bridging therapy while CAR T cells are manufactured](https://onco.cc/protocols/car-t-bridging/), [Infection screening, prophylaxis and immunoglobulin replacement around CAR T-cell therapy](https://onco.cc/protocols/car-t-infection-prevention/), [Leukapheresis to collect T cells for CAR T-cell manufacture](https://onco.cc/protocols/car-t-apheresis/), [Lymphodepleting chemotherapy before CAR T-cell infusion](https://onco.cc/protocols/car-t-lymphodepletion/)
- cancers: [Acute lymphoblastic leukaemia](https://onco.cc/cancers/all-leukemia/), [Diffuse large B-cell lymphoma](https://onco.cc/cancers/dlbcl/), [Follicular lymphoma](https://onco.cc/cancers/follicular-lymphoma/), [Mantle cell lymphoma](https://onco.cc/cancers/mantle-cell-lymphoma/), [Multiple myeloma](https://onco.cc/cancers/multiple-myeloma/), [Primary mediastinal (thymic) large B-cell lymphoma](https://onco.cc/cancers/primary-mediastinal-b-cell-lymphoma/)
- technologies: [Autologous stem cell transplant (high-dose therapy)](https://onco.cc/technologies/autologous-stem-cell-transplant/), [CAR-T cell therapy](https://onco.cc/technologies/car-t/)
- drugs: [Axicabtagene ciloleucel](https://onco.cc/drugs/axicabtagene-ciloleucel/), [Brexucabtagene autoleucel](https://onco.cc/drugs/brexucabtagene-autoleucel/), [Ciltacabtagene autoleucel](https://onco.cc/drugs/ciltacabtagene-autoleucel/), [Idecabtagene vicleucel](https://onco.cc/drugs/idecabtagene-vicleucel/), [Lisocabtagene maraleucel](https://onco.cc/drugs/lisocabtagene-maraleucel/), [Obecabtagene autoleucel](https://onco.cc/drugs/obecabtagene-autoleucel/), [Tisagenlecleucel](https://onco.cc/drugs/tisagenlecleucel/)
- terms: [The CAR-T pathway in lymphoma: referral, apheresis, bridging and the waiting](https://onco.cc/terms/lymphoma-tx-car-t-pathway/)

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