CAR T-Cell Therapy for Large B-Cell Lymphoma: What to Expect
Health ConditionsCancerLymphoma

What to Expect When Starting CAR T-Cell Therapy for Large B-Cell Lymphoma

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Published on January 6, 2026
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I f your doctor has recommended chimeric antigen receptor (CAR) T-cell immunotherapy for large B-cell lymphoma (LBCL), you’ve likely already tried several standard treatments, and the cancer did not respond or continued to grow.

CAR T-cell therapy is a revolutionary, essentially personalized, cellular treatment that harnesses your own immune system to fight cancer. Doctors collect your T cells (a type of white blood cell) and send them to a lab, where they are genetically modified to become superfighters against LBCL. These engineered cells are then infused back into your body, where they actively hunt and destroy the cancer.

This process is a “very exciting, very different way to attack the lymphoma,” says E. Anders Kolb, MD, a hematologist oncologist who is the president and CEO of Blood Cancer United. “If the therapy is effective, it can be curative.”

How to Prepare for CAR T-Cell Therapy for LBCL

Before you can start CAR T-cell therapy, your care team will assess whether your body is up to the task. “This can be a challenging treatment,” says Dr. Kolb, noting that leukapheresis, the process in which white blood cells are removed from the blood, can strain vital organs. “If you have an infection that isn’t well controlled or you’re having problems with your heart or kidneys, for example, the care team may decide to delay treatment or provide additional support during therapy.”

You’ll complete some tests to help your care team understand how your body is doing and what support you may need. You’ll also need to do some practical prep to ensure treatment and your daily needs are covered, and take some steps just before or on treatment days to make yourself comfortable and ensure the process goes as smoothly as possible.

    Treatment Steps

    CAR T-cell therapy is a multistep process that can take several months. It’s helpful to understand each step, so you feel prepared and confident throughout treatment.

    Step 1: T Cells Are Collected

    T cells are collected through leukapheresis. Think of it like a blood donation during which a special machine separates and collects T cells (the immune system’s main fighting cells) from your blood, which is then returned to your body. Here’s what happens:

    • When you arrive at the treatment center, a nurse will settle you into a bed or reclining chair and insert a thin catheter into a vein in your neck.
    • The catheter will connect to a machine that draws your blood, extracts white blood cells (including T cells), and returns the rest of the blood to your body.
    • A nurse will monitor you for side effects, such as numbness or tingling, which may be treated with calcium orally or through an IV.
    • Once enough T cells are collected, the catheter will be removed, and you’ll apply pressure to the insertion site for a few minutes. A nurse will then apply a bandage.
    • The full procedure takes about two to four hours, and you’ll need a caregiver to take you home afterward.

    Step 2: T Cells Are Engineered and Multiplied

    The T cells are then sent to a lab to be genetically engineered and become CAR T cells (powerful fighters against lymphoma):

    • An inactive virus is introduced to the surface of the cells to produce chimeric antigen receptors, or CARs, which give the T cells the ability to kill cancer cells.
    • The cells are multiplied in the lab over two to four weeks.
    • Once ready, the modified T cells are frozen and sent to the hospital or treatment center.

    Note: During this time, your immunity is compromised. When out in public, avoid large crowds and wear a mask to reduce the risk of infection. Consider spending your time doing relaxing activities, such as reading or taking leisurely outdoor walks.

    Step 3: Preconditioning Chemotherapy

    A few days before the CAR T-cell infusion, you’ll receive low-dose chemotherapy (also called lymphodepletion chemotherapy) to make space for the modified cells to reenter your body.

    • After you check in at the hospital or treatment center, a nurse will bring you to your treatment room. They’ll insert an IV into your arm to administer two chemotherapy drugs, cyclophosphamide and fludarabine, over about 30 minutes.
    • After the infusion, the IV will be removed, and your caregiver will take you home.

    Note: Some people are given more than one course of chemotherapy before the T-cell infusion.

    Step 4: CAR T-Cell Infusion

    After a day or two of rest, you’ll receive the CAR T-cell infusion at the hospital or treatment center as an outpatient procedure. Note that hospital admission may be required if you experience side effects.

    • A central venous catheter will be inserted for the infusion of blood products, fluids, and medication.
    • The CAR T-cell infusion can take 15 to 90 minutes, during which your vitals and blood counts will be monitored.
    • Afterward, the catheter will be removed, and the care team will monitor you for side effects.
    • Your caregiver should stay with you for support and monitoring during your hospital stay and for several weeks after you’re discharged.

    Treatment Timeline

    Side Effects of CAR T-Cell Therapy

    CAR T-Cell therapy can affect both your body and mind. During T-cell collection, you might feel muscle spasms, numbness, or tingling due to temporary drops in calcium. Your care team may give you calcium orally or through an IV to help.

    The process can also take an emotional toll. Anxiety, mood swings, and stress are common, and strategies such as listening to music, meditating, practicing deep breathing, or talking with a counselor or support group can help. Having a caregiver nearby also provides practical and emotional support.

    Brain fog, itchiness or rash, low blood pressure, mild fever, and upset stomach are common side effects that can occur directly after CAR T-cell therapy. Many of these side effects can be managed with supportive care and medication or may even resolve on their own.

    But you’re also “at risk for different toxicities with the therapy,” explains says Dr. Riedell. So, it’s important to monitor side effects to ensure they aren’t part of a more serious reaction. This can include:

    • Cytokine release syndrome (CRS), which is characterized by inflammation that presents as fever and can affect multiple organs
    • Immune effector cell–associated neurotoxicity syndrome (ICANS), which can affect the brain and nervous system

    Symptoms of CRS and how to manage them:

    Symptoms of ICANS and how to manage them:

    Additionally, these side effects can occur weeks — or even months — after a CAR T-cell infusion:

    • Anemia Low red blood cells can cause fatigue, lightheadedness, or shortness of breath.
    • Low Platelet Count This can cause bruising or prolonged bleeding from cuts.
    • Neutropenia This occurs when a low white blood cell count increases your risk of infection.

    Your care team can help you monitor for side effects and determine if additional treatment for CRS or ICANS is necessary. Be sure to update them if you notice any new or worsening side effects.

    Real-Life Tips for CAR T-Cell Therapy

    Do everything you normally would expect to do to try to stay healthy. Stay active and maintain a healthy diet. That is your best preparation.

    — Robyn Stacy-Humphries, diagnosed with LBCL in 2011

    — Robyn Stacy-Humphries, diagnosed with LBCL in 2011
    You can’t do it by yourself. It’s hard if you don’t have a support system. For me, my wife was there, and she knew how I was feeling.

    — Dennis Maki, 70, diagnosed with LBCL in 2021

    — Dennis Maki, 70, diagnosed with LBCL in 2021
    I sort of felt like I had the flu for a month — not terrible, just lousy, but it passes. … Walking and light exercise really do help.

    — Stacy-Humphries

    — Stacy-Humphries
    If you need to stay close to the hospital, like I did for a month (in case of side effects), look into places like Hope Lodge, run by the American Cancer Society. They provide free lodging for people with cancer.

    — Maki

    — Maki
    The therapy is more difficult mentally than physically. Anxiety comes from wondering if it’s working, but focusing on positive and fun things helps.

    — Stacy-Humphries

    — Stacy-Humphries

    Know What’s Next

    Going through treatment for LBCL can feel overwhelming, and CAR T-cell therapy adds its own set of steps, testing, and emotional ups and downs. Many people describe the process as something that takes preparation and patience. But people who’ve gone through it are grateful it was an option when other treatments didn’t work.

    As doctors gain more experience administering CAR T-cell therapy, more people with LBCL may be able to consider it. Researchers are also exploring whether CAR T-cell therapy could be used earlier in the treatment journey, whether the process can be made less time intensive, and whether future versions might come with fewer side effects.

    If you’re wondering whether CAR T-cell therapy — or future advancements — could play a role in your care, talk with your care team. They can help you understand what to expect and weigh the benefits and risks, so you can make decisions that feel right for you.

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    Tingting Tan, MD, PhD

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    Tingting Tan, MD, PhD, is a medical oncologist at City of Hope National Medical Center.

    Dr. Tan's research has been published in multiple medical and scientific journals, including Oncologists, Cancer Cell, and Genes and Development.

    A graduate of the Beijing Medical University, Tan holds an M.D. from Peking University Health Science Center and a Ph.D. from Rutgers University. Her training includes fellowships at the University of California San Francisco Cancer Research Institute and the Fox Chase Cancer Center at Temple University.

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