CAR-T FOR DLBCL
IN INDIA

CAR-T is the standard of care recommendation for relapsed/refractory DLBCL after two or more prior lines of chemoimmunotherapy, per NCCN, ESMO, and the Indian consensus guidelines.

“CAR-T is not a last resort for DLBCL — it is the standard recommended therapy at third-line, and India makes it financially accessible for the first time to patients globally.”

• R/R DLBCL After 2+ Lines of Therapy

  Patients who relapse or are refractory after at least two prior lines — typically R-CHOP followed by R-ICE or R-DHAP — are eligible for CAR-T. This is the approved indication for both NexCAR19 and Kymriah in India.

• Which DLBCL Subtypes Are Eligible?

  DLBCL NOS (not otherwise specified), transformed follicular lymphoma (tFL), high-grade B-cell lymphoma (HGBCL), and PMBCL are generally included in the approved indication. PCNSL (primary CNS lymphoma) is a contraindication. T-cell rich B-cell lymphoma eligibility should be confirmed with the treating team.

Eligibility assessment is conducted at the treating centre and covers performance status, organ function, disease status, and absence of absolute contraindications.

• Key Inclusion Criteria

  CD19+ confirmed DLBCL on pathology. ECOG performance status 0–1 (PS 2 considered on a case-by-case basis). Adequate organ function: creatinine ≤1.5× ULN, ALT/AST ≤5× ULN, LVEF ≥50% on echo. At least 2 prior lines of chemoimmunotherapy.

• Absolute Contraindications

  Active CNS lymphoma (leptomeningeal or parenchymal). Uncontrolled active infection. Prior allogeneic SCT within 6 months or active GvHD. Active autoimmune disease requiring systemic immunosuppression. LVEF <50%. These criteria are applied at eligibility review.

NexCAR19 achieved 58% complete remission in its DLBCL cohort — comparing favourably to the JULIET trial (Kymriah) and contextually to ZUMA-1 (Yescarta), which used a different patient population.

Most DLBCL patients with active or rapidly progressing disease will need bridging chemotherapy during the 3–4 week CAR-T manufacturing period to prevent disease progression before infusion.

1. 1

   Disease Staging at Leukapheresis

   PET-CT or CT staging performed at or around leukapheresis. Tumour burden and growth kinetics assessed to determine bridging need.

2. 2

   Bridging Chemotherapy Selection

   R-GemOx (rituximab + gemcitabine + oxaliplatin) is the most commonly used bridging regimen in India — well-tolerated and effective. R-DHAP (rituximab + dexamethasone + cytarabine + platinum) is an alternative.

3. 3

   Response Assessment Pre-Infusion

   PET-CT or CT reassessment approximately 1 week before planned infusion to confirm patient remains eligible and guide lymphodepletion strategy.

4. 4

   Lymphodepletion

   Fludarabine + cyclophosphamide for 3 days (Day -5 to Day -3). Patient admitted for inpatient monitoring.

5. 5

   CAR-T Infusion

   NexCAR19 or Kymriah infused as a 30–60 minute IV infusion. CRS monitoring begins immediately.

• $35–50KNexCAR19 All-In IndiaManufacturing + lymphodepletion + inpatient monitoring at Tata Memorial Centre.
• $180–250KKymriah All-In IndiaKymriah via Immuneel including hospitalisation at Apollo or Manipal.
• 3–4 wksManufacturing TimeFrom leukapheresis to infusion-ready product for both NexCAR19 and Kymriah.
• 14–28 daysInpatient MonitoringPost-infusion inpatient stay for CRS/ICANS surveillance at Indian centres.

Explore treatment timeline, CRS management, cost details, and the broader CAR-T India guide.

Frequently Asked Questions: CAR-T for DLBCL in India