Clinical and Biological Correlates of Resistance and Relapse After CD19-Directed CAR T-Cell Therapy in Large B-Cell Lymphoma: A Structured Narrative Review

Background/Objectives: CD19-directed chimeric antigen receptor (CAR) T-cell therapy has transformed the treatment of relapsed/refractory large B-cell lymphoma (r/r LBCL), yet primary resistance and relapse remain common. We evaluated how recent clinical and translational evidence refines established resistance frameworks and which knowledge gaps prevent the relative contribution of individual mechanisms from being determined.

Methods

We conducted a structured narrative review of 14 selected clinical and translational studies addressing tumor-, product-, host-, and microenvironment-related dimensions of treatment failure, synthesized across four interpretive domains and compared with nine previous reviews.