Most lymphomas, which are blood cancers, are either B-cell or T-cell types. Only 15% are T-cell lymphomas, while the majority are B-cell lymphomas.
Within B-cell lymphoma, there are Hodgkin’s lymphoma and non-Hodgkin’s lymphoma. Non-Hodgkin’s lymphoma (NHL) includes many types of lymphoma, such as an aggressive variant called large cell lymphomas.
This includes:
- diffuse large B-cell lymphoma (DLBCL)
- high grade B-cell lymphoma (HGBCL)
- mantle cell lymphoma (MCL)
- primary mediastinal B-cell lymphoma (PMBCL)
- follicular lymphoma grade 3B (G3BFL)
CAR T therapy is one of the few approved treatments for blood cancers. It is approved for use in specific cases of multiple myeloma, B-cell acute lymphoblastic lymphoma, and large B-cell lymphomas.
Six CAR T-cell therapies
- idecabtagene vicleucel (Abecma)
- tisagenlecleucel (Kymriah)
- brexucabtagene autoleucel (Tecartus)
- lisocabtagene maraleucel (Breyanzi)
- axicabtagene ciloleucel (Yescarta)
- ciltacabtagene autoleucel (Carvykti)
Some patients will have to meet certain criteria for CAR T therapy, such as having:
- relapsed or refractory DLBCL within 12 months of their first treatment
- relapsed or refractory cancer after trying two or more treatments for DLBCL, HGBCL, PMBCL, or G3BFL
Candidates for CAR T-cell therapies are those whose conditions meet the criteria for treatment and who are considered “medically fit.”
Some CAR T-cell therapies are restricted by age, such as those for young adults up to age 25 years with relapsed or refractory B-cell acute lymphoblastic leukemia. However, for most therapies, it’s up to the healthcare professional to decide if a person is medically fit for treatment.
Medical fitness is determined by a person’s physical health, ability to perform daily activities independently, and cognitive function (thinking and memory).
The effectiveness of CAR T-cell therapies varies depending on the specific type of blood cancer being treated.
A 2021 study found that axicabtagene ciloleucel was more effective for relapsed or refractory large cell lymphoma, delaying condition progression for about 8 months compared to just 2 months with other standard second-line therapies.
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Non-Hodgkin’s lymphomas are a wide range of blood cancers. They can grow slowly over months or years or double in size within just a few weeks.
If left untreated, a person with aggressive NHL (large cell lymphomas) has a life expectancy of fewer than 12 months and, in some cases, fewer than 6 months.
CAR T-cell therapy should be considered when the first treatment doesn’t work. Talking about it early on can help plan possible future options.
Dr. Sheel Patel is an ABMS board certified physician in hematology, oncology, and internal medicine. Dr. Patel is a practicing physician at the Orlando VA Medical Center in Florida. He specializes in genitourinary oncology.