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In 2017, the FDA approved a cutting-edge treatment for diffuse large B-cell lymphoma (DLBCL), the most common type of lymphoma. It’s called chimeric antigen receptor T-cell therapy, or CAR T-cell therapy for short. It has been approved for people who have not been helped by other treatments for DLBCL. Could you be a candidate to receive this treatment? Let’s take a look.

What Is CAR T-Cell Therapy?

CAR T-cell therapy is an immunotherapy. That’s a type of treatment that uses your body’s immune system to fight your cancer. When you have this treatment, doctors remove white blood cells called T cells from your body. Scientists then alter the genes inside those T cells in order to transform them into cancer killers. When they return these cells to your body, they attack your cancer.

Why Might I Need CAR T-Cell Therapy?

DLBCL is a potentially curable type of cancer. The standard treatment involves a combination of monoclonal antibody therapy and chemotherapy. About 60% of people with DLBCL do very well on this treatment. Some are considered cured. However, 40% of patients will require some other form of treatment.

This second treatment often includes more chemotherapy. If your cancer responds to chemo, your doctor may combine that with a stem cell transplant (also called a bone marrow transplant) if you are healthy enough to tolerate the potential side effects of that treatment.

This second round of treatment also may fail to cure DLBCL. About half of those who undergo a transplant, for example, live an average of just 10 months after the procedure. That’s where CAR T-cell therapy comes in.

Am I Eligible for CAR T-Cell Therapy?

If you’ve already tried at least two different kinds of treatment and you fall into one of the following two categories, you may be eligible to have CAR T-cell therapy:

  • Relapsed. This means that your cancer has come back after it had gone into remission. In other words, your treatment (or treatments) did not cure you; they only held your cancer at bay temporarily.
  • Refractory. This means that you did not respond to the treatment or treatments that you received or that they only provided a brief benefit.

You also must be healthy enough to undergo this treatment.

Will CAR T-Cell Therapy Ever Be Offered Sooner?

Right now, experts are asking a big question: Should CAR T-cell therapy be used earlier in treatment? If they determine the answer is yes, that would mean that people with DLBCL could receive CAR T-cell therapy if they don’t do well on their first treatment rather than undergoing a second round of chemo.

Until now, doctors haven’t offered the treatment right at diagnosis because research hadn’t shown it to be more effective than the current standard treatment for DLBCL. But three large clinical trials involving people with DLBCL have given researchers reason to reconsider.

Two of those trials showed that people who received CAR T-cell therapy after a single round of chemotherapy lived longer without their cancer getting worse than those who had a second round of chemo and a stem cell transplant. The third trial found no such difference.

What Can I Expect From CAR T-Cell Therapy?

CAR T-cell therapy can be very effective. Some studies have shown that as many as 60% of people had a complete response to treatment. That means that after treatment, they had no signs of cancer. However, about 60% of those who had benefited from CAR T-cell therapy at first saw their cancer return and progress after an average of 6 months.

Right now, experts don’t know why some people do better than others on CAR T-cell therapy. That’s a question they are working to solve in order to better determine who will benefit from this treatment.

In a 2021 study, for example, researchers found that the cancer cells in some lymphoma patients had transformed themselves from one type of cancer cell into another. That may have allowed them to avoid being targeted by the CAR T cells. Further research may allow scientists to overcome this hurdle and offer a treatment that’s effective for more people with DLBCL.

Do I Need to Be Healthy Enough for CAR T-Cell Therapy?

The side effects of CAR T-cell therapy can be serious and even life-threatening. The treatment will make your immune system less able to fight off infections. For this reason, your doctor may want you to be in good general health aside from your cancer to consider it as a treatment for you.

You may need to stay in the hospital for 1 to 2 weeks after treatment. For 30 days after treatment, you must remain within 2 hours of the hospital so that you can get there quickly if necessary. Also, you must have a caregiver with you at all times -- 24 hours a day, 7 days a week -- in order to watch you and arrange care if you become ill. Here are the most common side effects:

Cytokine release syndrome (CRS). CAR T cells trigger a buildup of cytokines, chemicals that help your immune system fight disease. This buildup can cause fevers, nausea, and other flu-like symptoms. But CRS also can be life-threatening. It can cause abnormal heartbeat (arrhythmia), cardiac arrest, organ failure, and other side effects that require immediate intensive care.

Neurologic toxicities. This means that your treatment may impair your nervous system. Usually this is temporary or treatable. You may experience speech problems, confusion, tremors, delirium, hallucinations, seizures, and loss of balance.

CAR T-cell therapy also can cause potentially severe allergic reactions (anaphylaxis). It may weaken your immune system and lower your blood cell counts, both of which increase your risk of infection.

How Can I Participate in a Clinical Trial?

A clinical trial can give you access to the latest, potentially lifesaving treatments and expert medical care before it’s approved for the public. Clinical trials also help advance science and medicine. They do this by enlisting volunteers in studies that aim to determine whether a treatment in development is both safe and effective.

In the United States right now, there are many ongoing or planned clinical trials focused on CAR T-cell therapy for DLBCL. Visit clinicaltrials.gov to find a trial in your area.

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SOURCES:

Leukemia and Lymphoma Society: “Diffuse Large B-Cell Lymphoma (DLBCL),” “Chimeric Antigen Receptor (CAR) T-Cell Therapy.”

American Cancer Society: “CAR T-cell Therapy and Its Side Effects,” “Treating B-Cell Non-Hodgkin Lymphoma.”

National Cancer Institute: “CAR T Cells: Engineering Patients’ Immune Cells to Treat Their Cancers,” “Should CAR T Cells Be Used Earlier in People with Non-Hodgkin Lymphoma?,” “Tecartus Becomes First CAR T-Cell Therapy Approved for Adults with ALL.”

Lymphoma Research Foundation: “Diffuse Large B-Cell Lymphoma.”

Blood Advances: “Outcomes in patients with DLBCL treated with commercial CAR T cells compared with alternate therapies.”

News release, Stanford University.

Dana Farber Cancer Institute: “Frequently Asked Questions About CAR T-Cell Therapy.”

Memorial Sloan Kettering Cancer Center: “CAR T Cell Therapy: A Guide for Adult Patients & Caregivers.”

Clinicaltrials.gov

Stanford Medicine: “Study predicts who may benefit from CAR-T cell therapy for blood cancers.”

Fred Hutchinson Cancer Center: “Does CAR T-cell therapy leave patients vulnerable to infection?”