Closing the CAR T access gap: what the latest evidence at EHA 2026 is telling us

This article was supported by Kite, a Gilead company, through Gilead Sciences Europe Ltd, which provided funding and content support. Dr Anna Sureda is a member of the CAR T Vision consortium, an initiative partially funded by Gilead and Kite. Complete editorial control rests with the author.

For clinicians treating aggressive lymphoma, one of the hardest realities is knowing that a patient may be clinically eligible for a therapy, but still not reach it in time.

CAR T-cell therapy is an innovative and individualised treatment option that reprogrammes a patient’s own T cells to recognise and destroy cancer cells. Where available, it has improved outcomes for patients with aggressive blood cancers compared to traditional therapies, creating possibilities that were once out of reach. ¹ Yet across many health systems, clinical possibility has moved faster than access.

Relapsed or refractory large B-cell lymphoma can progress quickly. A patient who appears suitable for CAR T-cell therapy at one appointment may deteriorate while a referral is completed, funding is confirmed, a treatment slot is found, or travel and caregiver support are arranged. From the outside, these steps can look procedural, but for the patient in front of us, they can become the difference between receiving treatment and missing the opportunity altogether.

For example, across Europe, utilization remains uneven and, in some settings, far below what we should accept. Uptake has been reported as low as 11% of eligible patients in some countries. In France, it is around 30%; in Germany, under 40%; and in Spain, closer to 25%. ² These are not places where CAR T-cell therapy is unknown or unavailable, but health systems where the route to treatment remains too slow, too variable, or too difficult.

For those of us working in this field, the barriers to access are well known because we see them in real patient journeys. They appear in the patient who is referred only after their disease has progressed, the older patient whose suitability is questioned before a specialist team has assessed them, or the family trying to manage travel, accommodation and caregiver responsibilities while urgent decisions are being made. They also appear in the less visible parts of the pathway: reimbursement steps, centre capacity, and scheduling and coordination between hospitals.

While many systems are still evolving as they better understand what it takes to deliver this innovative treatment class safely and effectively, there is now a clear opportunity to keep refining these pathways as clinical evidence, physician experience and real-world use continue to mature.

From availability to access

Growing experience with CAR T-cell therapy has helped refine how patients are managed, while real-world evidence has supported more practical approaches to delivery. Recent European updates to post-infusion management guidance reflect this evolution, with more flexible, evidence-based approaches that may reduce the burden on patients, caregivers and treatment centres while maintaining appropriate safety standards. ³ As knowledge and experience expand, collaboration amongst stakeholders is key to ensuring pathways are optimised for both effective delivery and timely patient access.

This is where initiatives such as CAR T Vision, a multi-stakeholder initiative focused on improving timely and equitable access to CAR T-cell therapy, have an important role. ⁴ By bringing together clinical leaders, patient advocates, health system experts and policymakers, CAR T Vision aims to address the points where patients are most often lost, helping close the gap between those eligible for CAR T-cell therapy and those ultimately treated, with a goal of doubling the proportion of eligible patients treated by 2030. ⁴  

What emerging evidence is telling us

Too often, we talk about access as though it ends once a therapy is approved and reimbursed. For patients, access is tested in everything that follows; whether they are recognised early, referred quickly, assessed consistently and supported practically enough to reach treatment in time.

That is why the emerging evidence being discussed around the European Haematology Association Congress 2026 feels so relevant, as it points toward several key themes that reflect the pathway as clinicians experience it. Not as one isolated challenge, but as a series of connected points where eligible patients can still fall away.

One important message is that time matters. For patients with aggressive lymphoma, delays in recognition, referral, assessment or treatment planning can have real consequences, reinforcing the need for pathways that move with the urgency of the disease itself. ⁵

Another is the need for clearer and more consistent referral decision-making. Eligibility for CAR T-cell therapy should not be narrowed prematurely or assumed to mirror eligibility for other intensive treatments. Patients deserve timely specialist assessment based on a contemporary understanding of who may benefit. ⁶

Consistency after referral is also a crucial part of the access equation. As CAR T-cell therapy becomes more established in routine practice, greater alignment around evidence-informed practice could help reduce avoidable variation and support more predictable pathways for patients and clinical teams. ⁷

Taken together, these themes point toward a practical conclusion: access cannot be addressed only at the point of CAR T infusion. It has to begin earlier, with timely response assessment, clear referral triggers, rapid specialist review and a shared understanding that eligibility can be lost if the system takes too long to act.

Where pathways need to adapt

Through CAR T Vision, the response is framed as practical system improvement rather than an abstract ambition. Multi-factorial barriers require multi-stakeholder action, starting with awareness and referral: helping clinicians outside specialist centres identify patients earlier and refer with urgency, while supporting patients and caregivers to understand CAR T-cell therapy before decisions are being made in crisis.

Resources and capacity are equally important. Referring hospitals and CAR T-cell therapy centres need to operate as one connected pathway, with diagnostics, eligibility assessment, treatment planning and follow-up moving without avoidable friction. Continued investment in capacity and service design is also needed to meet patient demand and avoid delays or bottlenecks that can prevent timely access. Progress already seen across the field – including increasing experience with toxicity management, evolving outpatient approaches where appropriate, and European label updates reflecting more flexible post-infusion management supported by real-world evidence – should help inform more consistent and scalable delivery models.

Sustainable access also depends on better evidence generation, clearer policy frameworks and regulatory approaches that recognise both the urgency of aggressive disease and the importance of timely access to innovation. Recent international comparison data show why this matters: in European countries where CAR T-cell therapy is available to treat patients with large B-cell lymphoma, only about two out of 10 eligible patients are ultimately treated with it. ² If we are to close that gap, any processes that support access must ultimately move at the pace of the disease; because a decision that comes too late may still fail the patient it was designed to support.

A moment to align

EHA 2026 offers an opportunity to look beyond emerging science and ask whether health systems are organised to deliver on the evidence already available. CAR T Vision provides a mechanism to bring policymakers, payors, providers, patient groups and industry around shared priorities: clearer referral pathways, faster movement through the system, more consistent delivery models and fewer structural access barriers.

CAR T-cell therapy has already changed the treatment conversation. The question now is how health systems, working with stakeholders, can build on that progress so more eligible patients are identified, assessed and treated within the window where CAR T-cell therapy can offer meaningful clinical benefit. Through CAR T Vision, we hope to work with others who share this goal and are committed to closing the gap between eligibility and access.

To learn more about this work and the priorities guiding it, please visit the CAR T Vision website.

References

1 National Cancer Institute. CAR T Cells: Engineering Patients’ Immune Cells to Treat Their Cancers. Available at: https://www.cancer.gov/about-cancer/treatment/research/car-t-cells Last accessed: June 2026.

2 IQVIA Institute Report. Achieving CAR T-cell Therapy Health System Readiness. Available at: https://www.iqvia.com/insights/the-iqvia-institute/reports-and-publications/reports/achieving-car-t-cell-therapy-health-system-readiness Last accessed: June 2026.

3 European Medicines Agency. Yescarta® (axicabtagene ciloleucel) SPC. Available at: https://www.ema.europa.eu/en/documents/product-information/yescarta-epar-product-information_en.pdf Last accessed: June 2026.

4 CAR T Vision. Homepage. Available at : https://cartvision.com/ Last accessed: June 2026.

5 De Holanda Farias, J. et al. Axicabtagene Ciloleucel for the Treatment of Relapsed/Refractory Diffuse Large B-Cell Lymphoma in Brazil: The Impact of CAR T-Cell Therapy Wait Time and Treatment Sequencing. Presented at the European Hematology Association (EHA) Congress, 11-14 June 2026, Stockholm, Sweden.

6 Thieblemont C. et al. International Expert Consensus on Real-World CAR T-cell Eligibility in Large B-cell Lymphomas: An e-Delphi Study. Presented at the European Hematology Association (EHA) Congress, 11-14 June 2026, Stockholm, Sweden.

7 Yamshon S. et al. Global Variation in CAR T-cell Therapy Practice Patterns for LBCL: Quantitative Research Findings. Presented at the European Hematology Association (EHA) Congress, 11-14 June 2026, Stockholm, Sweden.