Noopur Raje, MD, Marcela Maus, MD, PhD and Matthew Frigault, MD discuss the power and evolution of immune therapies, specifically, CAR T-Cell therapy in treating cancer.
Explore CAR T-Cell Therapies
CAR T-cell therapy is a type of cellular immunotherapy which targets a patient’s own immune cells to use directly against their cancer cells. Unlike traditional drugs, CAR T-cells are a “living drug”, where a single infusion can produce deep and durable remissions.
Mass General Cancer Center is an authorized treatment center for FDA approved CAR T-cell therapies for adult patients with lymphoma (Breyanzi, Kymriah, Tecartus and Yescarta) and for adult patients with multiple myeloma (Abecma).
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, including diffuse large B-cell lymphoma (DLBCL) not otherwise specified (including DLBCL arising from indolent lymphoma), high-grade B-cell lymphoma, primary mediastinal large B-cell lymphoma, and follicular lymphoma grade 3B.
Kymriah is FDA approved for adult patients with relapsed or refractory large B-cell lymphoma after two or more lines of systemic therapy including diffuse large B-cell lymphoma (DLBCL) not otherwise specified, high grade B-cell lymphoma and DLBCL arising from follicular lymphoma.
Tecartus is FDA approved for the treatment of adult patients with relapsed/refractory mantle cell lymphoma (r/r MCL).
Yescarta is FDA approved for adult patients with relapsed or refractory large B-cell lymphoma (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 which 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.
Learn more about Mass General Cancer Center's Lymphoma treatment program.
Abecma is FDA approved for the treatment of adult patients with relapsed or refractory multiple myeloma after four or more prior lines of therapy including an immunomodulatory agent, a proteasome inhibitor, and an anti-CD38 monoclonal antibody.
Learn more about Mass General Cancer Center's Multiple Myeloma treatment program.
Here you will find information that you need to know about treatment with CAR T-Cell Immunotherapy for Lymphoma. For more details, please refer to our brochure.
What are T-cells?
T-cells are lymphocytes, which are a type of white blood cells. White blood cells fight infection.
What is immunotherapy?
Immunotherapy is a type of cancer treatment that uses the body’s immune system to find and attack cancer cells. CAR T-cell therapy is a type of immunotherapy.
What is CAR T-cell therapy? How does it work?
CAR T-cell therapy uses your own immune system to help fight cancer cells. Your blood is collected through a process called apheresis, sometimes called leukapheresis. This process separates your T-cells from the rest of your blood. The T-cells are then sent to a lab where they are engineered specifically to attack B-cell lymphoma cells. The engineered T-cells are then multiplied and shipped back to the hospital. Back in the hospital, the cells are given back to you through an IV infusion.
CAR T-cell therapy is a complex treatment. It can cause severe side effects. Because of this, it is only given during a stay in the hospital. You will be carefully monitored by your treatment team for any side effects. You will also be told about side effects and how to best care for yourself after you leave the hospital.
What is apheresis?
T-cells are collected from your blood by apheresis, a process that takes blood from the body and removes one or more blood components such as plasma, platelets, or white blood cells. The remaining blood is then returned to the body.
What is an infusion reaction?
An allergic response when the CAR T-cells are being infused into your blood. Your treatment 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.
How long will I need to stay in the hospital?
Your hospital stay may range from one week to one month, or potentially longer. The length of stay depends on your body’s reaction to the CAR T-cell infusion and possible side effects.
What side effects should I be aware of?
You will be very carefully monitored after your infusion for any side effects. Report any of these side effects to your treatment team right away!
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, which can include confusion, excessive sleepiness, tremor, or seizures
- Decreased blood counts
- Increased risk of infection
- 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:
- Excessive sleepiness
- Symptoms of infection
Family members are often the first to notice changes in behavior such as trouble remembering or confusion. Family members should report these changes to your treatment team.
What can I expect before my CAR T-cell infusion?
- You will have a medical and laboratory evaluation with a lymphoma specialist to determine if CAR T-cell therapy is right for you.
- Your lymphoma will be re-staged with a PET-CT scan, if one has not been recently performed.
- You will meet with a social worker to evaluate your psychosocial needs and determine the support we can provide you and your family.
- You will undergo apheresis, a process where your blood is collected and processed to obtain the T-cells.
- Before being admitted to the hospital, you will receive chemotherapy that is designed to prepare your body for the CAR T-cell infusion.
- Your nurse will talk with you about your supportive care team members. You will meet with an Oncology Social Worker. You have access to a Nutritionist, Spiritual Care Provider, or a member of the Parenting At a Challenging time (PACT) team at any time before, during, and after your infusion.
How should I prepare? What do I need to know now to prepare for my care after my infusion?
- You should have someone living with you in your house for at least one month after your infusion.
- You should avoid driving or operating heavy machinery for up to 2 months after your infusion.
- You must live within 2 hours drive of the hospital for a month after your infusion.
- You will need to set up a healthcare proxy, if you do not already have one. Your treatment team can provide you with a healthcare proxy form.
- You will receive a patient wallet card and should carry it with you at all times. If you see a doctor, you should give this card to them.
What should I do to care for myself after I leave the hospital?
Your treatment team will talk with you about how to care for yourself when you leave the hospital. They will give you specific information about personal care, mouth care, and hand washing. They can answer any other questions that you may have.
For more information about treatment with CAR T-Cell Immunotherapy for Lymphoma, please refer to our brochure.
Learn more about CAR T-Cell Therapy in this series of videos.
Related News and Articles
- Mar | 14 | 2022
Billy Costa talks with Dr. Matt Frigault and oncology social worker Lauren DeMarco to learn more about the latest in CAR T-cell therapies and what it all means for patients.
- Jul | 8 | 2021
Immunotherapy is a cancer treatment that works by boosting the body’s immune system. Some patients achieve full remission, meaning all signs of their cancer have disappeared.