Clinical update

Alternative therapy to be offered for people with large-cell lymphoma

NICE offers alternative therapy for those diagnosed with lymphoma 

National Institute for Health and Care Excellence offers alternative therapy for those diagnosed with lymphoma 

Chimeric antigen receptor T-cell therapy. Picture: Science Photo Library

Essential facts

About 12,000 people in the UK are diagnosed with lymphoma every year, according to the charity Bloodwise. People over 50 are the most likely to develop the disease but it is also the most common type of cancer in children and young adults. Treatment usually involves a combined approach that can include chemotherapy, radiotherapy, biological therapies, steroids or stem-cell transplant.

What’s new

NHS England has announced that adults whose large-cell lymphoma has returned or stopped responding to treatment will now be able to receive chimeric antigen receptor T-cell (CART-T) therapy, previously only available through clinical trials.

CAR-T therapy involves genetic modification of the patient’s own white blood cells so that they can recognise and attack certain cancers. Once modified, the re-engineered cells are infused back into the patient.

It is expected that up to 200 patients a year in England will receive the treatment – called axicabtagene ciloleucel, also known as Yescarta.

Earlier, NHS England announced that CAR-T therapy will also be made available to children and young people with a rare form of leukaemia and it has also this month received approval from the National Institute for Health and Care Excellence (NICE) for this patient group.

What others say

In August, NICE said in draft guidance that axicabtagene ciloleucel was ‘promising’ and that results from a small trial indicated most people given the treatment responded favourably.

But NICE recommended against its availability on the NHS because of cost, although it did invite further comment and evidence.

Since then, however, NHS England has struck a deal with Yescarta’s manufacturer while NICE is expected to publish revised final guidance soon.

NHS England chief executive Simon Stevens described CAR-T therapy as ‘one of the most promising treatments in a generation’.

What this means for cancer nurses

Outcomes for those with refractory or relapsed large B-cell and primary mediastinal large B-cell lymphoma – aggressive subtypes of non-Hodgkin lymphoma – are poor and survival is limited. CAR-T therapy offers new hope for these patients for whom two or more previous therapies have failed.

But the treatment is complex and can trigger severe side effects, such as cytokine release syndrome, so patients who are given CAR-T therapy will, as a minimum, require close monitoring and supportive care from expert teams that include nurses. Initially, the treatment will only be available at five NHS centres, in Birmingham, Bristol, London, Manchester and Newcastle.

Expert comment

Órla Stewart is lead nurse in haematology at King’s College Hospital NHS Foundation Trust

'For the NHS to enable this level of personalised medicine is truly ground-breaking. Further work continues to be undertaken to develop this therapy in other lymphomas, myeloma, acute myeloid leukaemia and acute lymphoblastic leukaemia, as well other types of cancers such as neuroblastoma and melanoma. This is an exciting time to be in haematology nursing.

'The impact on nursing care is significant as these therapies have unique side effects. The therapies will, at least initially, only be delivered in a small number of centres – testament to the expertise required to deliver treatment safely.

'Education and training of our nursing workforce is essential for the effective management of this complex treatment, and shared learning and peer support will help.

'Given the level of excitement surrounding CAR-T nationally and globally, we’re fortunate to be at the forefront of this exciting development.'


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