The discovery and development of tisagenlecleucel for the treatment of adult patients with relapsed or refractory follicular lymphoma.

INTRODUCTION: Follicular lymphoma (FL) is an indolent yet incurable subtype of non-Hodgkin lymphoma characterized by repeated relapses and diminishing responses with each treatment line. Although front-line chemoimmunotherapy achieves high initial response rates, a subset of patients - particularly those with early relapse (POD24) - experience poor outcomes and require alternative therapies. Tisagenlecleucel (tisa-cel), a CD19-directed chimeric antigen receptor (CAR) T-cell therapy, has emerged as a promising option for relapsed or refractory (r/r) FL, offering the potential for deep and durable remissions.

AREAS COVERED: This review covers the scientific rationale, preclinical innovations, and clinical development of tisa-cel, from its origins in 2nd-generation CAR-T engineering to its pivotal trials in hematologic malignancies. It is based on a literature search using PubMed, Embase, and conference abstracts from major hematology meetings from 1987 to April 2025. The paper deta ils the ELARA trial outcomes, subsequent long-term and real-world data, and the competitive landscape of third-line therapies for r/r FL.

EXPERT OPINION: Tisa-cel has demonstrated high response rates and sustained remissions with a favorable safety profile in heavily pretreated FL, including high-risk populations such as those with POD24. While bispecific antibodies offer convenient outpatient administration, CAR-T cell therapy provides the potential for deep and durable remissions. The 4-1BB costimulatory domain used in tisa-cel and liso-cel is associated with a lower incidence of severe CRS and ICANS compared to CD28-based constructs. the field evolves, careful patient selection and head-to-head trials will be essential to refine therapeutic sequencing in r/r FL.