CAR T-Cell Therapy for Lymphoma

CAR T-cell therapy for lymphoma is for some patients who have not responded to other treatments. The procedure targets relapsed or refractory lymphomas, including large B-cell lymphoma, high-grade B-cell lymphoma, mediastinal large B-cell lymphoma, follicular lymphoma, and mantle cell lymphoma.

What Is CAR T-Cell Therapy?

CAR T-cell therapy is a kind of personalized immunotherapy that uses the body's immune system to find and attack cancer cells.

In CAR T-cell therapy for lymphoma, your blood is collected through a process called apheresis. This process separates your T-cells—a type of white blood cell that fights infection—from the rest of your blood. The T-cells are sent to a lab where they are engineered to attack lymphoma cells. The engineered T-cells are multiplied before being reintroduced to your body through an IV infusion.

CAR T-cell therapy is a complex treatment that can cause severe side effects, so patients who receive CAR T-cell therapy for lymphoma will need to stay in the hospital to receive it. While in the hospital, your doctors will monitor you for any side effects of CAR T-cell therapy. Before you're sent home, you'll receive guidance about managing side effects and follow-up care.

How Does CAR T-cell Therapy Work?

In CAR T-cell therapy for lymphoma, a lab modifies a patient's blood cells to help them fight cancer cells in the blood. Once a patient's blood is drawn, a lab engineers the T-cells to gain a chimeric antigen receptor (CAR), which can bind to a protein on the cancer cells. The CAR T-cells are multiplied to produce more engineered T-cells. When there are enough of these special cells, they are reintroduced to the patient via a blood infusion.

What Is Apheresis?

Apheresis is the process doctors use to collect T-cells from your blood. They remove some blood, separate out the blood components they need to develop your treatment, and then return the remaining blood to your body.

What Is an Infusion Reaction?

You may have an allergic response when your care team introduces the CAR T-cells. Your team will monitor your vital signs and labs closely during your CAR T-cell infusion. You will also be given Tylenol and Benadryl before the CAR T-cell infusion to help stop a reaction.

What to Expect When You Get CAR T-Cell Lymphoma Therapy

Before you get CAR T-cell therapy for lymphoma, you will have a medical and laboratory evaluation with a lymphoma specialist to determine if CAR T-cell therapy is right for you. The specialist will re-stage your lymphoma with a PET-CT scan unless you've recently had one.

Then, a social worker will help you evaluate your psychosocial needs and determine how we can support you and your family.

Finally, you start the therapy process:

• First, you will undergo apheresis to obtain the T-cells.
• Before beginning your CAR T-cell therapy for lymphoma, you will receive chemotherapy that will help prepare your body for the CAR T-cell infusion.
• Your nurse will talk with you about your supportive care team members, including an oncology social worker. You will also have access to a registered dietitian, spiritual care provider, or a member of the parenting at a challenging time (PACT) team when you need them—before, during, and after your infusion.

What to Expect After the Infusion

Your treatment team will talk with you about how to care for yourself after your hospital stay. You'll learn specific information about personal care, mouth care, and hand washing. They can answer any other questions that you may have.

Additionally, you may need to change your lifestyle after your CAR T-cell therapy. Specifically:

• You'll need someone living with you for at least one month after your infusion.
• You should avoid driving or operating heavy machinery for up to 2 months after your CAR T-cell treatment.
• You must live within a two-hour drive of the hospital for a month after your infusion.
• You must set up a healthcare proxy (unless you already have one). Your treatment team can provide you with a healthcare proxy form.
• You will receive a patient wallet card that you should carry at all times.

In addition to inpatient, we are currently infusing FDA-approved Breyanzi in an outpatient setting. To see if you might be a candidate for outpatient treatment, speak with your care team.

FAQs About CAR T-Cell Therapy for Lymphoma

Who is Eligible for CAR T-Cell Therapy for Lymphoma?

CAR T-cell therapy is intended for cases where the condition either hasn't responded to traditional methods or has relapsed. To be eligible for CAR T-cell therapy, you must typically have undergone prior treatment with standard chemotherapy. Your care team will evaluate your eligibility and recommend CAR T-cell therapy for lymphoma if it's a good option for you.

How Successful is CAR T-Cell Therapy for Lymphoma?

CAR T-cell therapy has a verifiable track record of improving outcomes for patients who haven't found success with other treatments. Some studies show that up to 50% of patients treated with CAR T-cell therapies have found lasting remission with no additional treatment.

What Are the Possible Side Effects of CAR T-Cell Therapy?

Your team will monitor you carefully for side effects after your infusion. Report any of these side effects to your treatment team immediately.

Possible side effects include:

• Cytokine release syndrome (CRS), which can include fevers, low blood pressure, low oxygen levels, fast heartbeat, confusion, and temporary kidney and liver abnormalities
• Neurologic toxicities, with symptoms like confusion, excessive sleepiness, tremor, or seizures
• Decreased blood counts
• Increased risk of infection
• Fever
• Chills
• Swelling in hands, arms, feet, and legs
• Increased risk of bleeding

If you experience any of these side effects after you leave the hospital, call your treatment team right away:

• Fever
• Confusion
• Excessive sleepiness
• Seizures
• Symptoms of infection
• Bleeding

Family members may be the ones to notice behavioral changes like confusion or memory issues. Loved ones and caregivers should report these changes to your treatment team.

How Long Will I Need to Stay in the Hospital?

Your hospital stay may range from one week to one month. In some cases, it may last longer. The length of stay depends on your body's reaction to the CAR T-cell infusion and possible side effects.

Is CAR T-Cell Therapy FDA Approved for Lymphoma?

Mass General Cancer Center is an authorized treatment center for FDA-approved CAR T-cell therapies for adult patients with lymphoma and leukemia and for adult patients with multiple myeloma.

CAR T-cell treatment options for lymphoma include:

• Breyanzi: Breyanzi is FDA-approved for the treatment of adult patients with relapsed or refractory large B-cell lymphoma after two or more lines of systemic therapy. Types of lymphoma treated by Breyanzi may include high-grade B-cell lymphoma, primary mediastinal large B-cell lymphoma, follicular lymphoma grade 3B, and diffuse large B-cell lymphoma not otherwise specified (DLBCL-NOS).
• Kymriah: Kymriah is FDA-approved for adult patients with relapsed or refractory large B-cell lymphoma who have already received two or more lines of systemic therapy. Types of lymphoma treated by Kymriah include high grade B-cell lymphoma, DLBCL arising from follicular lymphoma, and DLBCL-NOS.
• Tecartus: Tecartus is FDA-approved to treat adult patients with relapsed/refractory mantle cell lymphoma (r/r MCL).
• Yescarta: Yescarta is FDA-approved for adult patients with relapsed or refractory DLBCL, primary mediastinal large B-cell lymphoma (PMBCL), high-grade B-cell lymphoma, and DLBCL arising from follicular lymphoma (transformed follicular lymphoma). Patients must have received two or more other forms of cancer treatment that did not successfully treat their cancer. Yescarta is also FDA-approved for adult patients with relapsed or refractory follicular lymphoma (FL) after two or more lines of systemic therapy.

Additional Options

View Cellular Therapy clinical trials.

View Lymphoma clinical trials.

How Long Does CAR T-Cell Therapy Last for Lymphoma?

While every case is different, studies on CAR T-cell therapy show significant remission rates even five years after the treatment. Make sure to speak with your oncologist for more information.