Primary Mediastinal B-Cell Lymphoma: CAR T-Cell Therapy

If you've tried at least two traditional treatments for primary mediastinal B-cell lymphoma (different combinations of chemotherapy drugs, plus the monoclonal antibody rituximab [Rituxan] and radiation) and they haven't worked, or your cancer has come back, CAR T-cell therapy is a new option your doctor might recommend.

It's different from other treatments because it trains your own immune cells to find and kill cancer. In 2017, the FDA approved the first CAR T-cell therapy for PMBL and a few other types of non-Hodgkin's lymphoma. The treatment is called axicabtagene ciloleucel (Yescarta).

CAR T-cell therapy is a different kind of cancer treatment. It's called a "living drug" because it keeps killing cancer cells in your body long after you get it.

CAR stands for chimeric antigen receptor. It's a type of gene therapy.

How It Works

First, a small amount of your blood is drawn. T cells -- immune cells that help your body fight germs like bacteria, as well as cancer -- are taken out of it.

The CAR gene is added to your T cells. Then the T cells are multiplied. Finally, the modified cells are put back into your body. Once there, they help your T cells find and kill lymphoma cells long after your treatment.

How Effective Is It?

Studies of CAR T-cell therapy have been done on people with PMBL and a few other types of lymphoma who didn't respond to at least two other cancer treatments. CAR T-cell therapy helped more than half of those people reach remission, which means tests show no signs of the cancer.

In one study, 82% of people who got Yescarta to treat their type of lymphoma responded to it. Of those, 52% had a complete response -- meaning they had no signs of cancer. More than a year after treatment, 40% of people were still in remission.

Side Effects

Yescarta can cause side effects, and some of them are serious. It carries a black box warning -- the FDA's most serious warning -- about the risk of cytokine release syndrome (CRS) and problems with the nervous system.

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Cytokines are immune system substances that have different actions in your body. CAR T-cell therapy can cause CRS when it releases a flood of cytokines into your body.

People with CRS have symptoms such as:

  • Fast heartbeat
  • Low blood pressure
  • Trouble breathing
  • Fever
  • Nausea
  • Headache
  • Rash

These side effects can sometimes be life-threatening. That's why doctors and nurses at hospitals that use CAR T-cell therapy are trained to quickly identify and treat the symptoms of CRS.

Neurological side effects can include:

  • Tremors
  • Headaches
  • Confusion
  • Loss of balance
  • Trouble speaking
  • Seizures
  • Hallucinations

Other possible side effects from CAR T-cell therapy include:

Neutropenia: A lack of white blood cells called neutrophils in your blood. Neutrophils protect your body against infection.

Anemia: A shortage of red blood cells. You need them to move oxygen throughout your body.

B-cell aplasia: The number of B cells you have goes down.  These are white blood cells that produce antibodies.

Thrombocytopenia: Low levels of platelets in your body. Platelets help your blood clot when you have an injury.

When to Consider CAR T-Cell Therapy

It could be an option if you've tried two or more other treatments for PMBL, and they haven't stopped your cancer. Talk to your doctor about the benefits and risks of this treatment to see if it's right for you.

WebMD Medical Reference Reviewed by Laura J. Martin, MD on May 07, 2018

Sources

SOURCES:

American Cancer Society: "Treating B-Cell Non-Hodgkin Lymphoma."

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

FDA: "FDA approves CAR-T cell therapy to treat adults with certain types of large B-cell lymphoma."

Massachusetts General Hospital: "CAR T-cell Therapy for Lymphoma: Yescarta."

National Cancer Institute: "Cytokine release syndrome."

New England Journal of Medicine: "Axicabtagene Ciloleucel CAR-T Cell Therapy in Refractory Large B-Cell Lymphoma."

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