axicabtagene ciloleucel + tisagenlecleucel + lisocabtagene maraleucel

This entry refers to the concurrent or sequential use of three CD19‑directed autologous CAR‑T cell therapies—axicabtagene ciloleucel, tisagenlecleucel, and lisocabtagene maraleucel—each manufactured from a patient’s own T cells and genetically modified to express a chimeric antigen receptor targeting the B‑cell antigen CD19. Axicabtagene ciloleucel incorporates a CD28 costimulatory domain and is approved for relapsed/refractory large B‑cell lymphomas and follicular lymphoma.[1][2] Tisagenlecleucel (4‑1BB costimulatory domain) is approved for B‑cell acute lymphoblastic leukemia and certain relapsed/refractory diffuse large B‑cell lymphomas, while lisocabtagene maraleucel (also 4‑1BB‑based) is approved for relapsed/refractory large B‑cell lymphomas.[3] In combination, these products would be expected to deplete CD19‑expressing malignant and normal B cells through CAR‑mediated T‑cell activation, expansion, cytotoxicity, and cytokine release, but such use is non‑standard and not supported by regulatory approvals or routine clinical practice.