How does CAR-T for MZL work? 

The FDA-approved CAR T-cell therapy for MZL in the United States is:

• Liso-cel (Breyanzi)

Liso-cel enhances your T cells to target CD19 on MZL cells. Learn more at: How CAR T-cell Therapy Works. 

Which MZL patients can receive CAR-T? 

People with MZL are eligible for the CAR-T construct in the following situation:

• Liso-cel: Adult patients with relapsed or refractory MZL who have received at least 2 prior 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 MZL 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 an anti-CD20 directed treatment, corticosteroids, chemotherapy, or a BTK inhibitor to help keep MZL under control until your CAR-T infusion. 

How is CAR T-cell therapy administered for MZL?

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. It helps prepare your body so CAR-T works more effectively. Your 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). 

Liso-cel (Breyanzi) for MZL

How effective is liso-cel for MZL?

Results from the TRANSCEND-FL study, which tested liso-cel after two or more treatments for people with relapsed or refractory MZL, showed that 62.1% of participants experienced a complete remission. After 24 months, 89% of these patients remained in remission. 33.3% of patients experienced a partial remission. After 24 months, 93.3% of these patients remained in remission. 

Side effect profile of liso-cel for MZL

The data below shows the percentage of people with MZL who experienced the 5 most common and severe side effects 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. 

The 5 most common side effects (any grade) that MZL patients experienced after receiving liso-cel were:

• Cytokine release syndrome: 76%
• Infection: 31%
• Diarrhea: 28%
• Fatigue: 27%
• Musculoskeletal (muscle/bone) pain: 22%

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

• Infection with pathogen unspecified: 6%
• Cytokine release syndrome: 4.5%
• Decreased appetite: 3%
• Edema (swelling in limbs from trapped fluid): 3%
• Fatigue: 3% 

For more information on liso-cel for MZL, 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.

Financial resources for MZL CAR-T

To locate financial resources for MZL CAR T-cell therapy like liso-cel, visit: Financial Resources for Lymphoma CAR-T.