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. But 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 have 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 one or two 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 have this treatment.
When Can I Get CAR T-Cell Therapy?
The CAR T-cell therapies axicabtagene ciloleucel (Yescarta) and lisocabtagene maraleucel (Breyanzi) are sometimes used as a second-line treatment after a single round of chemotherapy or as a third-line treatment. You might get tisagenlecleucel (Kymriah) as a third-line treatment. In recent studies including people with aggressive B-cell lymphoma, those who received CAR T-cell therapy after just one round of chemotherapy lived longer without their lymphoma getting worse than those who received the standard treatment.
There are other benefits of CAR T-cell therapy as a second-line treatment. The treatment time is shorter, and with fewer aggressive chemotherapy treatments, recovery is also shorter and may be somewhat easier for some people.
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. But 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 intensive care right away.
Neurologic toxicities. This means that your treatment may impair your nervous system. Usually this is temporary or treatable. You may have 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 Take Part 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 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.
Show Sources
Photo Credit: Tom Werner / Getty Images
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?”
The New England Journal of Medicine: "Axicabtagene Ciloleucel as Second-Line Therapy for Large B-Cell Lymphoma."
Blood: "Lisocabtagene maraleucel as second-line therapy for large B-cell lymphoma: primary analysis of phase 3 TRANSFORM study."
News release, FDA.
UpToDate: "Diffuse large B cell lymphoma (DLBCL): Suspected first relapse or refractory disease in medically-fit patients."
