Issues with CAR T-Cell Therapy in Follicular Lymphoma

Chimeric antigen receptor (CAR) T-cell therapy has proven to be a successful therapy for a number of conditions; however, we do not see the same success in follicular lymphoma and other lymphomas. In fact, only 35 to 40 percent of patients reach long-term remission. There are a number of reasons for this low percentage, and Sattva S. Neelapu, MD, explains them along with a possible solution in a discussion with Targeted Oncology.

CAR T-Cell Therapy for Lymphoma

Sattva S. Neelapu, MD, is a professor at The University of Texas MD Anderson Cancer Center working in the Department of Lymphoma/Myeloma. In his discussion, he initially points out the high response rate of CAR T-cell therapy, which sits around 80%. He notes the significance of this statistic but goes on to talk about the low long-term remission rate.

Issues with CAR T-Cell Therapy

About 35 to 40 percent of relapsed refractory large B-cell lymphoma patients treated with this therapy achieved long-term remission, leaving the remaining 60 to 65 percent to relapse. Neelapu names a number of issues that contribute to this problem.

Firstly, the CAR T-cells may not work due to previous chemotherapy treatments, the lymphoma itself, or the disease. Any of these factors could cause the cells to be dysfunctional. Manufacturing also presents issues. Because the cells are taken from the patient, there is a longer wait time between harvesting the cells and administering the therapy. It tends to take around three to four weeks.

Additionally, a number of patients (anywhere from ten to fifteen percent) are unable to receive CAR T-cell therapy when referred. The long wait time plays a role in this, as does accessibility. There are only one or two centers in each state throughout the country, making it difficult for patients to travel to and receive treatment. Not everyone can take five to six weeks away from home.

The Solution

Neelapu went on to name a possible solution for some of these issues: an over-the-counter CAR T-cell therapy from healthy donors. This version of the therapy would shorten wait times and increase accessibility. It would also address some of the dysfunction caused by prior treatment and the cancer itself.

About Follicular Lymphoma

Follicular lymphoma is a form of non-Hodgkin’s lymphoma, and it is typically a slow-growing cancer. It tends to impact those above the age of 60 and accounts for one of every five cases of lymphoma. This cancer occurs when the DNA of B-cells mutates, making them grow and divide rapidly. These abnormal cells then crowd out the healthy ones, causing the characteristic symptoms and lowering the body’s ability to fight infections.

Symptoms include:

  • Fever
  • Night sweats
  • Swollen lymph nodes
  • Shortness of breath
  • Weight loss

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