Consultant, Haemato-Oncology & BMT, Fortis Hospital, Shalimar Bagh, New Delhi
Part 8 of 8 in CAR-T Cell Therapy
The Future of CAR-T Cell Therapy: Beyond Lymphoma and Leukaemia
September 6, 2026
Lymphoma and leukaemia are only the starting point for CAR-T cell therapy. Dr. Akash Khandelwal walked through the cancers this technology is already reaching, and where he expects it to go next.
Myeloma, CLL, AML and paediatric cancers
CAR-T is already approved in the US for multiple myeloma, and new CAR-T constructs for chronic lymphocytic leukaemia and acute myeloid leukaemia are moving through Phase 1 and Phase 2 trials. A great deal of work is also underway in paediatric cancers such as Ewing's sarcoma, extending the therapy well beyond the adult B-cell cancers it is best known for today.
Early signals in solid tumours
Solid cancers, including brain tumours and kidney cancers, are showing real potential for CAR-T as well, alongside gene therapy more broadly, which Dr. Khandelwal describes as right next to the field's doorstep. Continued progress in both areas should make CAR-T more potent and more widely available across a broader range of cancers.
Next-generation CAR-T constructs
Beyond single-target CD19 CAR-T, researchers are developing dual-target CAR constructs and modifications that help CAR-T cells expand more easily and persist in the body for longer, addressing the durability challenge that currently limits long-term responses. Dr. Khandelwal's own outlook is direct: he expects CAR-T to become a first-line option in almost all cancers within the next five to ten years, and says that if it doesn't get there, the field will have missed something, given how differently and precisely it targets cancer cells compared with older treatments.
This article is based on a Jivo Masterclass session conducted by Dr. Akash Khandelwal, Consultant, Haemato-Oncology & BMT, Fortis Hospital, Shalimar Bagh, New Delhi. The article has been summarised with the assistance of an AI tool from the original masterclass recording. Watch the full Masterclass recording
This guide is based on a live Jivo Masterclass: Dr. Akash Khandelwal taught doctors across Africa on March 9, 2025.
FROM THE LIVE Q&A
Moderator
Where do you see CAR-T cell therapy heading in other cancers?
Dr. Akash Khandelwal
CAR-T cells are likely to become a first-line option in almost all cancers within the next 5 to 10 years. If it doesn't get there, that would actually be a missed opportunity, because it targets cells in a very different and unique way. More and more data is showing increasing promise for the treatment.
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Frequently Asked Questions
If possible, could you share your slides with us so we can go through the presentation again?▼
Yes, no problem: the slides will be shared after the session.
How many CAR-T cells are required per kilogram of body weight?▼
The cutoff is 5 million CAR-T cells required per kilogram of the patient's body weight.
For the approved indications of relapsed or refractory diffuse large B-cell lymphoma and B-cell ALL, patients need to be over 15 years old. What is the name of the CAR-T product available in India, so I can look up the clinical trial research myself?▼
There are two CAR-T products commercially available in India right now, both targeting CD19. One is NexCAR19, made by ImmunoACT, which has been commercially available in India since December 2023, so there is more than a year of experience with it. The second product was launched only about a month back and is still underutilised. Both target CD19, the marker responsible for the B-cell response, so B-cell ALL and B-cell lymphoma are the appropriate targets, not Burkitt lymphoma (the CAR-T construct needed is different) or CNS lymphoma (which does not respond as well).
I also attend a gene and cell therapy conference in Vietnam, and my institution is developing its own academic clinical trial in CAR-T. Are there upcoming CAR-T trial opportunities in India that international patients could join?▼
Fortis Shalimar Bagh is in talks to run its own CD19-directed CAR-T clinical trial for lymphoma and leukemia. Myeloma CAR-T trials are also upcoming from other companies and should be commercially available in India by year end. However, international patients cannot be enrolled in Phase 1 or Phase 2 trials, since these require longer follow-up before DCGI grants approval based on long-term data for commercial or international use. Until then, the CD19 CAR-T that is already commercially available is the only option for international patients.
Do you have specific nutritional considerations for patients undergoing CAR-T cell therapy, especially in a setting with very limited access to CAR-T treatment centres?▼
Adequate T-cell collection is the rate-limiting step for CAR-T, and nutrition can affect that. If enough T-cells aren't collected, the only option is to wait and reattempt collection after about 6 months. Beyond that, nutrition doesn't play a major role, since the chemotherapy used for CAR-T is not very toxic and even a frail patient can undergo CAR-T therapy. Nutrition plays a bigger role in bone marrow transplants than it does in CAR-T cell therapy.
Is CAR-T cell therapy used for cancers besides lymphoma and leukaemia?▼
It is already approved in the US for multiple myeloma, and is in Phase 1 and Phase 2 trials for CLL, AML and paediatric cancers such as Ewing's sarcoma, with early potential also being explored in solid tumours like brain and kidney cancers.
What are next-generation CAR-T constructs?▼
Dual-target CAR constructs and modifications that help CAR-T cells expand more easily and persist longer in the body, aimed at making responses more durable than current single-target CD19 CAR-T.
Will CAR-T become a standard first-line cancer treatment?▼
Dr. Akash Khandelwal expects CAR-T to become a first-line option in almost all cancers within the next five to ten years, given how precisely and differently it targets cancer cells compared with older treatments.
In This Series: CAR-T Cell Therapy
- 1.CAR-T Cell Therapy
- 2.What Is CAR-T Cell Therapy and How Does It Work?
- 3.The CAR-T Cell Therapy Timeline: From Collection to Infusion
- 4.Who Is Eligible for CAR-T Cell Therapy?
- 5.Managing Complications After CAR-T Cell Infusion
- 6.CAR-T Cell Therapy Outcomes: What the Data Shows
- 7.The Cost and Availability of CAR-T Cell Therapy in India
- 8.The Future of CAR-T Cell Therapy: Beyond Lymphoma and Leukaemia