How does CAR-T for follicular lymphoma work?

There are three types of CAR T-cell therapy approved for follicular lymphoma in the United States. These include: 

• Axi-cel (Yescarta)
• Liso-cel (Breyanzi)
• Tisa-cel (Kymriah)

All three enhance your T cells to target CD19 on follicular lymphoma cells. Learn more at: How CAR T-cell Therapy Works.  

Which follicular lymphoma patients can receive CAR-T? 

People with relapsed or refractory follicular lymphoma are eligible for the different CAR-T constructs in the following situations: 

• Axi-cel:
  • Adult patients with relapsed or refractory follicular lymphoma who have received 2 or more lines of systemic therapy. 
• Liso-cel:
  • Adult patients with relapsed or refractory follicular lymphoma who have received 2 or more prior lines of systemic therapy.
  • Patients with follicular lymphoma grade 3B are eligible if they have either:
    • Refractory disease to first-line chemoimmunotherapy or relapse within 12 months of first-line chemoimmunotherapy.
    • Refractory disease to first-line chemoimmunotherapy or relapse after first-line chemoimmunotherapy, and are not eligible for a stem cell transplant due to co-existing health issues or age.
    • Relapsed or refractory disease after 2 or more lines of systemic therapy.
• Tisa-cel:
  • Adult patients with relapsed or refractory follicular lymphoma are eligible after 2 or more lines of systemic therapy. 

To learn about more factors that may influence whether CAR-T is right for you, visit: When to Consider CAR T-cell Therapy?

When will my CAR-T infusion for follicular lymphoma be ready? 

The CAR-T process takes time. After collecting your T-cells, it takes up to 4 weeks for the CAR-T infusion to be ready. 

During this waiting period, your doctor may recommend a temporary bridging therapy like corticosteroids or radiotherapy to help keep follicular lymphoma under control until your CAR-T infusion. 

How is CAR T-cell therapy administered for follicular lymphoma?

Before your CAR-T infusion, you will receive a short course of chemotherapy with cyclophosphamide and fludarabine through an IV daily for 3 days. This step is called lymphodepletion, and it helps prepare your body so CAR-T works more effectively. The CAR-T infusion is typically given 2 to 4 days after this chemotherapy. If you experience serious side effects from lymphodepletion, active infections, or inflammatory disorders, the CAR-T infusion may be delayed until these side effects are resolved. 

About 30 to 60 minutes before the CAR-T infusion, you will be given acetaminophen and diphenhydramine by your healthcare team to help lower the risk of side effects. The CAR-T infusion itself takes between 30 and 60 minutes.  

Afterward, you will be monitored closely for at least 7 days. This is to watch for possible side effects such as cytokine release syndrome (CRS) and neurological changes. You will also need to stay near the treatment center and avoid driving for at least 2 weeks after the infusion. The requirements used to be longer but were recently updated based on the FDA’s removal of the Risk Evaluation and Mitigation Strategies (REMS). 

Axi-cel (Yescarta) for follicular lymphoma

How effective is axi-cel for follicular lymphoma? 

Results from the ZUMA-5 study, which tested axi-cel after two or more treatments for people with relapsed or refractory follicular lymphoma, showed that 60% of participants experienced a complete remission and 31% a partial remission. After 18 months, 74.2% of these patients remained in remission. 

Side effect profile of axi-cel for follicular lymphoma 

The lists below show the percentage of people with follicular lymphoma who experienced the 5 most common and severe side effects from axi-cel in the ZUMA-5 trial. This information can help you understand what to expect and prepare for, as well as guide conversations with your care team about managing potential side effects.  

The 5 most common side effects (any grade) that follicular lymphoma patients experienced after receiving axi-cel were: 

• Fever: 85% 
• Cytokine release syndrome: 84%
• Infection: 83%
• Hypotension (low blood pressure): 51%
• Fatigue: 49%

The 5 most severe side effects in which patients required supportive hospital care (grades 3 and higher), apart from low blood counts, included: 

• Febrile neutropenia (fever from low neutrophils): 41%
• Infection: 26%
• Encephalopathy (a group of conditions that cause brain dysfunction): 16%
• Cytokine release syndrome: 8%
• Hypoxia (low levels of oxygen in body tissues): 8%

For more information on axi-cel for follicular lymphoma, check out the source below. 

• Yescarta Prescribing Information

For information on how to manage CAR-T side effects, visit: Side Effect Management of CAR T-cell Therapy for Lymphoma.

Liso-cel (Breyanzi) for follicular lymphoma 

How effective is liso-cel for follicular lymphoma? 

Results from the TRANSCEND-FL trial, which tested liso-cel after two or more treatments for people with relapsed or refractory follicular lymphoma, showed that 73.4% of participants experienced a complete remission and 22.3% a partial remission. After 18 months, 77.1% of these patients remained in remission.

Side effect profile of liso-cel for follicular lymphoma 

The list below shows the percentage of follicular lymphoma patients who experienced the 5 most common side effects (any grade) from liso-cel in the TRANSCEND-FL trial. This information can help you understand what to expect and prepare for, as well as guide conversations with your care team about managing potential side effects. 

• Cytokine release syndrome: 59%
• Musculoskeletal (muscle/bone) pain: 28%
• Headache: 28%
• Fatigue: 23%
• Constipation: 21% 

Additionally, the majority of patients experienced low blood counts that required supportive hospital care (grades 3-4). 

For more information on liso-cel for follicular lymphoma, check out the source below. 

• Breyanzi Prescribing Information

For information on how to manage CAR-T side effects, visit: Side Effect Management of CAR T-cell Therapy for Lymphoma. 

Tisa-cel (Kymriah) for follicular lymphoma 

How effective is tisa-cel for follicular lymphoma? 

Results from the ELARA study, which tested tisa-cel after two or more treatments for people with relapsed or refractory follicular lymphoma, showed that 68.1% of participants experienced a complete remission and 18.1% a partial remission. After 24 months, 66.4% of these patients remained in remission. 

Side effect profile of tisa-cel for follicular lymphoma 

The data below shows the percentage of follicular lymphoma patients who experienced the 5 most common and severe side effects from tisa-cel in the ELARA study. This information can help you understand what to expect and prepare for, as well as guide conversations with your care team about managing potential side effects. 

The 5 most common side effects (any grade) that follicular lymphoma patients experienced after receiving tisa-cel were: 

• Infections: 56%
• Cytokine release syndrome: 53% 
• Fatigue: 27%
• Musculoskeletal (muscle/bone) pain: 25%
• Headache: 25%

The 5 most severe side effects in which patients required supportive hospital care (grades 3 and higher), apart from low blood counts, included: 

• Infections: 17%
• Febrile neutropenia (fever from low neutrophils): 13% 
• Fatigue: 3%
• Diarrhea: 2%
• Nausea: 2%

For more information on tisa-cel for follicular lymphoma, check out the source below. 

• Kymriah Prescribing Information

For information on how to manage CAR-T side effects, visit: Side Effect Management of CAR T-cell Therapy for Lymphoma. 

Financial resources for follicular lymphoma CAR-T

To locate financial resources for follicular lymphoma CAR T-cell therapies like axi-cel, liso-cel, and tisa-cel, visit: Financial Resources for Lymphoma CAR-T.