Diffuse Large B-Cell Lymphoma (DLBCL) is a type of non-Hodgkin lymphoma (blood cancer) that affects the cells and organs of the immune system. There are different types of Diffuse Large B-Cell Lymphoma (DLBCL), including high-grade B-cell lymphoma and DLBCL that arise from follicular lymphoma.1
Diffuse Large B-Cell Lymphoma (DLBCL) is a type of non-Hodgkin lymphoma (blood cancer) that affects the cells and organs of the immune system. B cells, T cells and glands called lymph nodes make up the body’s immune system.
Sometimes, the cells inside a lymph node can grow abnormally and become cancerous.
Patients with Diffuse Large B-Cell Lymphoma (DLBCL) have abnormal (cancerous) B cells in their lymph nodes, and potentially in other parts of the body. DLBCL is often a very fast-growing (aggressive) form of lymphoma.1
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To determine if a person has Diffuse Large B-Cell Lymphoma (DLBCL), your care team will ask about your treatment history, followed by a thorough physical exam to look for possible signs of the disease, such as swollen lymph nodes at various parts of the body.
Often, a biopsy is done where a swollen lymph node is removed for testing. The sample is then tested in the lab by a pathologist to help identify the type of lymphoma and how mature it is. Imaging studies, such as X-ray scans, CT scans, MRI, or ultrasound, may also be done for a better understanding of the extent of the disease.
Enlarged lymph nodes, or lumps, are often the first symptoms of Diffuse Large B-cell Lymphoma (DLBCL). Other common symptoms to look out for include:
Risk factors refer to anything that increases one’s risk of getting cancer, but they do not determine the diagnosis as Diffuse Large B-Cell Lymphoma (DLBCL) patients may have few or no known risk factors. According to statistics, the risk for developing DLBCL is higher in adults aged 60 and above, and in men than women.
Factors within your control
Factors within your control
Diffuse Large B-Cell Lymphoma (DLBCL) is a type of non-Hodgkin lymphoma (blood cancer) that affects the cells and organs of the immune system. About 40% of Diffuse Large B-Cell Lymphoma (DLBCL) patients will not have success with traditional chemotherapy treatments.8 This means their cancer became resistant and was non-responsive to standard treatments (refractory Diffuse Large B-Cell Lymphoma).
Some patients whose Diffuse Large B-Cell Lymphoma initially responded to treatments later report that their blood cancer has returned (relapsed Diffuse Large B-Cell Lymphoma).
Prior to CAR-T cell therapy, patients with refractory or relapsed Diffuse Large B-Cell Lymphoma (DLBCL) had limited treatment options and substantially reduced survival. Studies have shown that among patients with relapsed or refractory Diffuse Large B-Cell Lymphoma (DLBCL):9
In the past, the treatment options for patients with R/R Diffuse Large B-Cell Lymphoma (DLBCL) included chemotherapy, radiation, or stem cell transplant. Since then, scientific advances and medical research have opened doors for new treatments, such as CAR-T cell therapy, for some types of non-Hodgkin lymphomas.
In cancer care, treatment options depend on several factors10, including the type and stage (extent) of the patient’s Diffuse Large B-Cell Lymphoma (DLBCL). It is best to consult with your care team on what the recommended treatment journey is for you.
CAR-T cell therapy, or Chimeric Antigen Receptor T-cell therapy, is a type of immunotherapy that enhances the body’s natural ability to treat cancer by using modified T cells.
CAR-T cell therapy involves altering the body’s T-cells, a type of white blood cell found in the immune system, with new receptors. This receptor is called a Chimeric Antigen Receptor, or CAR, and helps to target and stop the spread of cancer cells in the blood.
In order to collect the T cells, the patient’s blood is drawn through a process called Luekapheresis. This process takes 3 to 6 hours in order to extract the T cells from the body.
Patient’s collected T-cells are modified into CAR-T cells at a specialized manufacturing facility. The CAR-T cells are then transported back to the hospital, which usually takes 3 to 4 weeks, but timing and manufacturing outcomes can vary.
Before infusion, the physician will determine if a short course of chemotherapy is needed to prepare the body. Once ready, the patient will receive CAR-T cells through a single infusion that takes less than 30 minutes. At this stage, the increase in CAR-T cells may enhance the patient's ability to withstand against cancer cells.
In the short term, regular monitoring to manage side effects is essential. Whether the infusion was received in an inpatient or outpatient setting, it will be necessary to stay close to the treatment center for at least 4 weeks.
In the long term, the treatment team will establish a monitoring plan for ongoing follow-ups. The Food and Drug Administration (FDA) recommends that all patients be followed for 15 years after infusion. The treatment team will offer the patient participation in a long-term registry conducted by the Center for International Blood and Marrow Transplant Research (CIBMTR) for this follow-up. This information is used to help future patients and contributes to understanding the effects of CAR-T cell therapy in the real world outside of clinical trials.
CAR-T cell therapy stands out from other cancer therapies because it is an individualized therapy made from the patient’s own cells.
Each patient’s infusion is created from the T cells in their own immune system. CAR-T cells may remain active in the body and act as a “living drug” to stop the growth of any new cells that may grow cancerous.20 Long-term data suggests that some patients recovered within months of treatment, meaning all signs and symptoms of their leukemia has disappeared.
Unlike other treatments, CAR-T therapy is designed to be a one-time treatment either with or without hospitalization (and may be done in an in-patient or out-patient setting).In most cases, a short course of chemotherapy is needed to prepare your body for infusion1
CAR-T therapy does not require a donor as it uses one’s own cells for treatment1. Thus, it is helpful for patients who may be ineligible for stem cell transplant due to other co-morbidities, while not bearing the risks associated with a transplant. It is considered a widely studied and safe option.
CAR-T cell therapy might be the next step if initial treatments have not been working or the cancer has returned. It’s important to seek a second opinion to determine if CAR-T cell therapy is right for you or if the hospital you are treated at does not offer advanced treatments such as CAR-T.
T cell health declines over time and is also affected by additional lines of treatment, such as chemotherapy, which then lowers your overall response rates to CAR-T therapy.
Due to the aggressive nature of the disease, T cells collected in earlier stages can lead to better outcomes and a higher chance for complete recovery.21 T cells can be cryopreserved for up to 2 years.
CAR-T therapy may be associated with certain risks such as cytokine release syndrome (CRS) and neurological toxicities, which may be severe or life-threatening.
Please refer to the Prescribing Information for more details.
Novartis. (n.d.-a). I AM KYMRIAH: A Guide for Patients and Caregivers (Diffuse Large B-Cell Lymphoma).136665. – extracted from Novartis resource
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