Overcoming barriers to referral for CAR T-cell therapy in patients with non-Hodgkin aggressive B-cell lymphomas: A Delphi consensus

Chimeric antigen receptor (CAR) T-cell therapy has revolutionized the treatment of aggressive B-cell non-Hodgkin lymphoma, particularly in relapsed/refractory large B-cell lymphoma and mantle cell lymphoma. Despite its transformative potential, significant challenges persist in optimizing patient identification and referral pathways to ensure timely and equitable access. This expert consensus, developed through the Delphi methodology, analyzes key barriers to the referral process and proposes structured solutions to enhance collaboration between referring treatment centers (RTCs) and qualified treatment centers (QTCs). Our findings highlight the importance of early and timely identification of CAR T–eligible patients through standardized disease assessments and strategies to streamline patient access through structured collaboration between RTCs and QTCs that can help overcome patient-specific logistical challenges. Proposed solutions should be broadly applicable across different health care systems. Addressing these clinical and logistical barriers in the referral process will be crucial for maximizing the benefits of CAR T-cell therapy and expanding its accessibility to a broader patient population.