CAR T-Cell Therapy for Lymphoma

CAR T-cell therapy is a promising treatment for some patients with aggressive non-Hodgkin lymphoma (NHL) that has not responded to other therapies (refractory). It is a highly-specialized therapy that involves genetically modifying a patient's own T cells to attack their cancer. The FDA has approved two CAR T-cell therapies for lymphoma: Yescarta™ and Kymriah™. Dana-Farber/Brigham and Women's Cancer Center (DF/BWCC) is one of the first centers to make the FDA-approved therapies available as standard of care to patients who have not had effective treatment options.

  1. Yescarta (also referred to as axicabtagene ciloleucel) is approved for aggressive, relapsed and/or refractory diffuse large B cell lymphoma (DLBCL), primary mediastinal B-cell lymphoma, and transformed follicular lymphoma. The clinical trials of Yescarta showed the therapy to be highly effective with 82 percent of patients responding to the CAR T-cell therapy, including 54 percent who had a complete response (i.e., no sign of cancer). The most recent follow-up data shows that at a median 15.4 months after treatment, 40 percent of patients remain in complete remission, showing the lasting effectiveness of this therapy.
  2. Kymriah (also referred to as tisagenlecleucel) is approved for patients with relapsed or refractory (r/r) large B-cell lymphoma including diffuse large B-cell lymphoma (DLBCL), high grade B-cell lymphoma, and DLBCL arising from follicular lymphoma. In clinical trials, patients had strong responses from this therapy: 53 percent responded to treatment, with 40 percent achieving a complete response (i.e. no sign of cancer). Kymriah is also approved for patients with relapsed or refractory B-cell acute lymphoblastic leukemia (ALL) up to age 25. Learn more about Kymriah for pediatric B-cell ALL.

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, and sometimes hallucinations.