Chemotherapy, radiation, and immunotherapy are some of the main treatments for follicular lymphoma. If your cancer doesn't respond to these treatments or it changes to diffuse large B-cell lymphoma (DLBCL), you might be a candidate for a new approach, called CAR T-cell therapy.
What Is CAR T-Cell Therapy?
CAR T-cell therapy is a type of immunotherapy. CAR stands for chimeric antigen receptor. The therapy is a living treatment that takes your own immune cells and modifies them in a lab to target your cancer.
Your immune system sends out T cells to protect you from foreign invaders. These cells travel through your blood and seek out threats such as viruses, bacteria, and cancer cells.
T cells find these foreign substances by looking for proteins on their surface. Each T cell has its own protein, called a receptor, that helps it attach to a cancer cell and destroy it. Once a T cell finds a cancer cell, its receptor latches onto the antigen on the cancer cell's surface, just like a key fits into a lock.
CAR T-cell therapy adds a man-made receptor called a chimeric antigen receptor to your T cells in a lab, to help them find your cancer more easily. The lab multiplies the modified T cells into the hundreds of millions. Then they go back into your body. The CAR T cells target an antigen called CD19 on your lymphoma cells.
Who Gets It?
The FDA has approved several CAR T-cell therapies for certain people with follicular lymphoma.
Lisocabtagene maraleucel (Breyanzi) is approved to treat people with grade 3B follicular lymphoma. Grade 3B is a fast-growing type of lymphoma. It looks like diffuse large B-cell lymphoma (DLBCL) under a microscope, and doctors treat it the same way.
Breyanzi is for people who have already tried two or more treatments, such as chemotherapy and immunotherapy, and their cancer did not respond or it came back.
Axicabtagene ciloleucel (Yescarta) and tisagenlecleucel (Kymriah) treat people whose follicular lymphoma has changed to DLBCL. In about 15% of people with follicular lymphoma, the cancer eventually turns into DLBCL. Yescarta has also been approved for the treatment of follicular lymphoma that has relapsed or has not responded to at least two previous lines of therapy.
If you don't qualify for any of these approved treatments, you may be able to enroll in a clinical trial. Research studies test out new types and uses for CAR T-cell therapy. Ask your doctor if a clinical trial might be right for you.
How CAR T-Cell Therapy Can Help
CAR T-cell therapy is pretty new, and doctors still have a lot to learn about its long-term effects. But what they've seen so far in studies has been very promising.
CAR T-cell therapy gives doctors another option for treating follicular lymphoma. It can be helpful for people whose cancer didn't respond to the first treatments they tried -- called refractory follicular lymphoma. It might also help people who went into remission on another treatment but their cancer came back -- called relapsed follicular lymphoma.
One advantage to CAR T-cell therapy is that you need to have it only once. That's different from chemotherapy and radiation, which require several treatments. And the recovery from CAR T-cell therapy is much faster than it is after a stem cell transplant.
Studies show that CAR T-cell therapy helps people live longer without their cancer getting worse. This treatment has helped people stay in remission for years, even those whose cancer came back after other treatments. Because CAR T cells stay alive in your body, they may still be able to find and attack lymphoma cells if your cancer returns months or years later.