CAR T-Cell Therapy for Diffuse Large B-Cell Lymphoma

CAR T-cell therapy uses your own immune cells to fight cancer in a new way. It doesn’t boost or trigger your immune system. Instead, it changes immune cells called T cells so they target tumors directly. It’s been approved to treat certain types of leukemia and lymphoma. One is diffuse large B-cell lymphoma.

CAR T’s not for everyone. It’s only done at special cancer centers, so you might have to travel to have it. And it can have side effects that can be very serious. It also costs more than most other medical treatments.

But CAR T may work when other treatments haven’t.

Your doctor can help you decide if it might be right for you.

How Does It Work?

Normally, T cells hunt down and destroy cancer cells. But sometimes your T cells may not see your cancer or get rid of all of it. CAR T makes it easier for T cells latch onto cancer cells and kill them.

CAR T treatment starts when a special machine removes all the T cells from your blood. The cells are sent to a lab where scientists add a new gene to them. This makes proteins on the cells’ surface called chimeric antigen receptors (CARs). These proteins target tumor cells in your body.

The lab grows hundreds of millions of the new cells (now called CAR T cells). This takes about a week. Then, the cells are frozen and shipped back to the hospital or center where you’re treated. The last step is to put them back into your body and wait to see if they work.

Does It Cure Cancer?

It’s too early to know for sure. So far, CAR T has mainly been used in medical trials. Some participants have no signs of cancer -- even after 5 years.

What About Side Effects?

Like all cancer treatments, CAR T can cause serious side effects. Some of them can be fatal.

The biggest concern is a condition called cytokine release syndrome. It can cause a high fever and a big drop in blood pressure. CAR T can also kill off cells called B cells that you need to fight infections. And it can cause severe swelling in your brain.

These side effects are scary, but doctors are learning how to handle them.

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What Does It Cost?

You only need one treatment with CAR T. But that can cost hundreds of thousands of dollars. You may be in the hospital for weeks or months, and need help when you go home. So you have to pay for lots of care, too. Plus, CAR T’s so new, insurance companies haven’t figured out if, or how, to cover it.

What’s Ahead?

CAR T’s new, but scientists already are thinking about how to make it better. One idea is to use T cells from a donor. That way, the treatment’s ready when you need it. Some researchers are trying to make CAR T cells inside the body. Others want to make cells with an “off” switch to help prevent side effects.

WebMD Medical Reference Reviewed by Laura J. Martin, MD on May 06, 2018

Sources

SOURCES:

FDA: "FDA approval brings first gene therapy to the United States."

National Cancer Institute: "NCI Dictionary of Cancer Terms: CAR T-Cell therapy," "With FDA Approval for Advanced Lymphoma, Second CAR T-Cell Therapy Moves to the Clinic," "CAR T Cells: Engineering Patients’ Immune Cells to Treat Their Cancers."

American Cancer Society: "What is Cancer Immunotherapy?"

Dana-Farber Cancer Center: "CAR T-Cell Therapy: How Does It Work?" "How Treatment Works for CAR T-Cell Therapy Patients."

Evidence-Based Oncology: "With Approval of CAR T-Cell Therapy Comes the Next Challenge: Payer Coverage."

Clinical Advances in Hematology & Oncology: "The Use of CAR T Cells in Diffuse Large B-Cell Lymphoma and Mantle Cell Lymphoma."

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