Starting CAR T for Diffuse Large B-Cell Lymphoma

CAR T-cell therapy is a new way of treating certain types of lymphoma. It uses your body’s own T cells (a type of immune cell) to hunt down and kill cancer. It does this by adding a gene to your T cells so they can find and destroy tumors more easily.

CAR T isn’t for everyone. It might be an option if other treatments haven’t helped, or your cancer comes back. Some people treated with CAR T in clinical trials have gone into remission. That means they have no signs of cancer.

But there’s no guarantee CAR T will work for you, too.

Before starting CAR T, be sure you know:

  • How long it takes
  • Side effects
  • Costs

Then you and your doctor can decide if it’s right for you.

Going Through CAR T

CAR T happens in stages. The first is to remove all the T cells from your blood. To do this, your blood passes through a special machine. It filters out the T cells and returns the rest of the blood to your body. You’re connected to the machine through a catheter in your arm or chest.

You can relax on a recliner and read or watch TV while your cells are collected. The whole process takes 2 to 4 hours.

Then your T cells are sent to a lab, where scientists add a gene to them. That helps them recognize and destroy cancer cells. Once your T cells have the new gene, they’re called CAR T cells. The lab grows hundreds of millions of them. This usually takes about a week. The cells are frozen and shipped back to the cancer center where you’re treated.

While you wait for the CAR T cells, you may have more chemotherapy. This helps make space in your body for the new cells to grow and expand. CAR T cells may live in your body for a year or more.

Finally, the cells are put back into your bloodstream. It's done similarly to a blood transfusion. You may have it in the hospital or as an outpatient. Either way, your doctor will keep a close watch for side effects, which can start a few hours or days later. You’ll need to stay near your cancer center for a few weeks, in case you need medical care.

Continued

Side Effects

Unlike chemo, CAR T doesn’t cause nausea, vomiting, or hair loss. But it has other side effects that can be serious and sometimes fatal:

Cytokine release syndrome: Although this can make you very sick, it’s a sign your treatment’s working. Cytokines are chemicals in your body that help trigger the attack against cancer cells. When they flood your system all at once, it can feel like a bad case of flu. You could also get a very high fever and low blood pressure. These can be dangerous, but your doctor can treat them with steroids and other medicine.

B-cell aplasia: CAR T cells target a protein on cancer cells called CD19. This same protein is found on B cells, which help fight infection. When CAR T kills cancer cells, it wipes out your B cells, too. This raises your chance of an infection that could make you very sick. A treatment called intravenous immunoglobulin therapy helps replace the B cells you’ve lost.

Brain swelling: Your doctor may call this cerebral edema. Fortunately, this is rare. When it does happen, it can be fatal. You might notice other brain problems like confusion or seizures. These usually go away quickly without lasting harm.

Facilities that offer CAR T are required to have special training in recognizing and treating these side effects. They must also have treatments for these side effects readily available.

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

Sources

SOURCES:

National Cancer Institute: "NCI Dictionary of Cancer Terms," "CAR T Cells: Engineering Patients’ Immune Cells to Treat Their Cancers,"

Cure: "CAR T-Cell Therapy Yescarta Approved to Treat Non-Hodgkin Lymphoma."

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

Memorial Sloan Kettering Cancer Center: "About CAR T Cell Therapy."

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

Cancer Network: "NCI Genomic Analysis May Refine DLBCL Therapy," "Investigating CAR T-Cell in Patients With DLBCL, FL, and Other Lymphomas."

© 2018 WebMD, LLC. All rights reserved.

Pagination