CAR T-Cell Therapy's Important Role in Treating Lymphoma
- CAR T-cell therapy offers the possibility of long-term remission, even cure, for patients whose lymphoma resisted other treatments or has returned shortly after initial treatment.
- When a patient undergoes CAR T-Cell therapy, their T-cells are collected, genetically “re-armed” in a lab to recognize the CD19 protein on lymphoma cells, multiplied, and then returned to their bloodstream as a living drug that keeps patrolling for years.
- Currently there are three drugs on the market for patients eligible for CAR T-cell therapy: axicabtagene ciloleucel (axi-cel), tisagenlecleucel (tisa-cel), and lisocabtagene maraleucel (liso-cel).
- Side effects might include cytokine release syndrome (CRS), or a flu-like inflammatory surge that can cause fever, low blood pressure, or low oxygen levels, and other conditions — but these can often be managed by your healthcare team.
Dr. Manali Kamdar, associate professor and the clinical director of lymphoma services at the University of Colorado, tells SurvivorNet that before CAR T-cell therapy, or chimeric antigen receptor T-cell therapy, patients would often relapse after treatment with a chemotherapy combination.
Read MoreCAR T-Cell Therapy in a Nutshell
When a patient undergoes CAR T-Cell therapy, their T-cells are collected, genetically “re-armed” in a lab to recognize the CD19 protein on lymphoma cells, multiplied, and then returned to their bloodstream as a living drug that keeps patrolling for years.The collection and treatment process typically looks as follows:
- Collection: A specialist team draws your T-cells through a process called leukapheresis — similar to donating blood.
- Re-engineering: In an FDA-regulated lab, those cells are fitted with a chimeric antigen receptor (CAR) that recognizes CD19, a protein sitting on most DLBCL cells.
- Expansion & Quality Checks: The modified cells multiply to the hundreds of millions, are rigorously tested for safety, and frozen for transport.
- Lymphodepleting Chemotherapy: A short course of low-dose chemo clears space in the immune system so the new cells can thrive.
- One-Time Infusion: The CAR T-cells are thawed and returned through a standard IV line — usually in under 30 minutes.
- Activation & Surveillance: Inside the body, they expand, hunt, and destroy lymphoma, then persist as a living drug that can patrol for years.
Manufacturing once took 30-40 days, but leading companies have now slimmed the turnaround to roughly two weeks and aim for one week, which should let patients receive the therapy earlier in their disease course.
Currently Approved CAR T Products for DLBCL
“Three constructs are currently available: Liso-cel, Axi-cel, and Tisa-cel,” Dr. Kamdar explains. “These pivotal therapies have demonstrated excellent efficacy and manageable toxicity profiles.”
Axicabtagene ciloleucel (Axi-cel; brand name Yescarta)
This drug was first approved in 2017 for patients who had exhausted two prior treatments. In 2022, the label expanded to second-line use when DLBCL relapses within a year of first therapy.
Five-year follow-up of the pivotal ZUMA-1 study showed that 40% of treated patients are still alive and disease-free — an outcome once thought impossible for chemo-resistant disease.
Tisagenlecleucel (Tisa-cel; brand name Kymriah)
This drug was approved in 2018 for adults whose disease persisted after two therapies.
Real-world data on nearly 1,000 people show response rates (≈ 60 % overall, 45% complete) comparable to the original JULIET trial, confirming that everyday results match clinical-trial promises.
Lisocabtagene maraleucel (Liso-cel; brand name Breyanzi)
This drug was approved in 2021 for third-line use and cleared by the FDA in 2024 for certain second-line patients — including those too frail for stem-cell transplant.
The treatment shows high response (≈ 70 % overall; 50% complete) with lower rates of severe toxicity compared to earlier products.
CAR T-Cell Therapy Side Effects
Like all cancer treatments, CAR T-cell therapy can come with side effects, including:
- Cytokine Release Syndrome (CRS): This is a flu-like inflammatory surge that can cause fever, low blood pressure, or low oxygen levels. Up to 80% of patients experience some CRS; only 5-10% develop severe grades. Tocilizumab (an IL-6 blocker) and steroids quickly can settle most reactions.
- Immune-Effector Cell-Associated Neurotoxicity (ICANS): This condition can cause temporary confusion, word-finding trouble, or seizures in rare cases. It affects about 20-30% of patients overall; severe events are uncommon and usually reversible. Treatment could involve close neuro checks, steroids, seizure medicines, and ICU care if needed.
- Low blood counts & infection risk: This can stem from the short chemo “primer” and immune reset. It is managed with growth-factor shots, antibiotics, and sometimes IV immunoglobulin. Most complications appear within two weeks of infusion, which is why centers monitor patients daily (in hospital or nearby lodging) during that window.
Questions to Ask Your Doctor
- Am I eligible for a CAR T-cell therapy?
- Which medication do you recommend? Why?
- Are there resources available to help with travel, lodging, and other costs?
- What are the risks vs. benefits of CAR T-cell therapy in my case?
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