Aug. 20, 2025
Muhamad Alhaj Moustafa, M.D., M.S., a hematologist and oncologist, and his colleagues on the lymphoma team at Mayo Clinic Comprehensive Cancer Center in Jacksonville, Florida, frequently see complex diagnoses, including rare or refractory disease.
The benefits of novel therapeutics
To meet the needs of patients with complex cancers, Dr. Moustafa and his colleagues use the latest available treatments, including the bispecific antibodies epcoritamab, glofitamab and mosunetuzumab. These antibodies work by engaging T cells to directly target lymphoma cells.
Other novel therapeutics — such as antibody-drug conjugates, BTK inhibitors and CAR-T cell therapy — are also helping to significantly improve the treatment of patients who have exhausted other options. BTK inhibitors, for example, are especially helpful in treating rare types of lymphoma such as chronic lymphocytic leukemia and mantle cell lymphoma.
"These therapies offer new avenues for patients, particularly for those with difficult-to-treat lymphoma or disease that's come back or stopped responding to treatment," says Dr. Moustafa.
One of Dr. Moustafa's research interests is harnessing the potential of CAR-T cell therapy to optimize lymphoma outcomes. A recent article he co-wrote was the first to discuss the use of consolidative radiotherapy to counteract the local progression commonly seen in people with non-Hodgkin lymphoma who have residual fluorodeoxyglucose (FDG) activity after CAR-T cell therapy.
The researchers found that using consolidative radiotherapy for residual FDG activity 30 days after CAR-T cell therapy alters the pattern of relapse and improves rates of local relapse-free and progression-free survival. The article was published in Haematologica in 2023.
In a 2024 article published in Chinese Clinical Oncology, Dr. Moustafa and his co-author outlined the effectiveness of CAR-T cell therapy in extranodal diffuse large B-cell lymphoma (DLBCL), noting that it presents a "revolutionary treatment with remarkable clinical responses" in relapsed and refractory DLBCL.
Researchers at Mayo Clinic in Florida are currently in the process of opening their own clinical trial for CAR-T cell therapy.
Across its three sites, Mayo Clinic gives patients access to a large portfolio of clinical trials, Dr. Moustafa says, which is a critical component of advancing treatments for lymphoma, especially for advanced or complex disease.
Clinical trials give patients access to novel therapies that may be more effective than current standards of care, including experimental drugs, advanced biologics and targeted treatments.
"We have many clinical trials across the disease state, from first line treatment through refractory," Dr. Moustafa notes. "We combine novel agents along with other, common therapies to figure out future, effective treatments. And we work closely with our clinical research teams to ensure patients are offered the best trial options available based on their unique disease characteristics and treatment history."
Dr. Moustafa also points to the benefits of using autologous and allogeneic bone marrow transplant for people with aggressive disease who haven't responded to standard therapy. He also notes the use of advanced blood banking services as a way to help patients undergoing intensive therapies such as CAR-T cell therapy. Dr. Moustafa and his team transfuse patients on a daily basis in an outpatient setting and are able to provide special platelets and blood products that aren't available at other centers.
Advantages of multidisciplinary care
Still, Dr. Moustafa says the collaborative approach to treating blood cancers is one of the most important components of high-quality care.
He notes the lymphoma tumor board he introduced at Mayo Clinic in Florida, which brings together hematologists, radiologists, pathologists and other specialists to review each patient's diagnosis and discuss the best treatment strategies, ensuring no aspect of care is overlooked.
"This helps in determining the most effective treatment plan tailored to the patient's unique needs," Dr. Moustafa says, adding that integrating support services, such as physical therapy and nutritional counseling, into the approach also helps improve patient outcomes, reduce complications and increase patients' overall quality of life.
"Taking a holistic approach to patient care ensures they receive not only cutting-edge treatments but also the emotional and physical support they need during their treatment journey," he says.
When to refer a patient with lymphoma
Patients may benefit from a referral to a team of lymphoma specialists if they:
- Are looking for a second opinion on a diagnosis or treatment plan.
- Could benefit from access to a clinical trial.
- Have a complex, rare or advanced form of the disease, or relapsed or refractory lymphoma.
"Choose a center that is at the forefront of treatments and clinical trial access, but also choose one that takes a multidisciplinary, patient-centered approach to care, one that's dedicated to treating patients as whole individuals, not just as their disease," Dr. Moustafa says.
For more information
Saifi O, et al. Consolidative radiotherapy for residual fluorodeoxyglucose activity on day +30 post CAR T-cell therapy in non-Hodgkin lymphoma. Haematologica. 2023;108:2982.
Kahn S, et al. CAR-T cell therapy: Unravelling its potential in extra-nodal diffuse large B cell lymphoma. Chinese Clinical Oncology. 2024;13:31.
Refer a patient to Mayo Clinic.