CAR T-Cell Therapy for Lymphoma: What You Need to Know

October 27, 2017

CAR T-cell therapy, like all forms of cancer immunotherapy, seeks to sharpen and strengthen the immune system’s inherent cancer-fighting powers. It involves treating patients with modified versions of their own immune system T cells ­— white blood cells that help protect the body from disease.

CAR T-cell therapy has been approved by the U.S. Food and Drug Administration as standard therapy for some patients with:

  • Aggressive, relapsed and/or refractory diffuse large B cell lymphoma (DLBCL), primary mediastinal B-cell lymphoma, and transformed follicular lymphoma (drug names Yescarta and Kymriah)
  • Patients age 25 and under with relapsed or refractory B-cell acute lymphoblastic leukemia (drug name Kymriah)

“This is an important and exciting advance,” said Caron A. Jacobson, MD, Medical Director of the Immune Effector Cell Therapy program at Dana-Farber/Brigham and Women’s Cancer Center (DF/BWCC). “It opens up a new treatment for a group of patients who really needed another option.”

Caron A. Jacobson, MD
Caron A. Jacobson, MD.

Here’s what you need to know about CAR T-cell therapy for lymphoma.

CAR T-cell therapy is for some patients with aggressive NHL that has relapsed after or not responded to at least two prior lines of treatment.

Without CAR T-cell therapy, these patients would otherwise be referred to clinical trials or other therapies that have a 20 to 30 percent chance of eliciting a response, according to Jacobson.

“The purpose of clinical research for many years has been to try and find new drugs to help these patients — and there are certainly some that have been developed,” Jacobson said. “None have had the success that CAR T-cell therapy has had for these patients.”

CAR T-cell therapy has the potential to cause a host of side effects, including cytokine release syndrome (CRS) and neurotoxicity in some patients.

CRS can cause dangerously high fevers, extreme fatigue, difficulty breathing, and a sharp drop in blood pressure. Neurotoxicity, on the other hand, can result in side effects as mild as confusion, but can be much more severe — some patients have had difficulty with speaking and language, despite being alert, according to Jacobson.

Neurotoxicity usually starts around six days after treatment, persists for three to 10 days, and then starts to improve. Other general side effects can include:

  • Tremors
  • Headaches
  • Loss of balance
  • Trouble speaking
  • Seizures
  • Sometimes, hallucinations

Researchers are still determining whether CAR T-cell therapy can be used earlier in some patients with lymphoma.

Chemotherapy is still the main type of treatment for lymphoma — it’s highly effective and has well-known, generally well-managed side effects, Jacobson said. But if a patient is likely to fail on a second round of chemotherapy, should they be treated with CAR T-cell therapy first?

“Right now, we’re not there,” Jacobson said.

However, a clinical trial is underway comparing patients who receive CAR T-cell therapy after their first line of chemotherapy versus patients who move forward with a second line of chemotherapy as well as a possible autologous stem cell transplant.