Breyanzi (lisocabtagene maraleucel) is a type of cancer treatment known as CAR T-cell therapy. Its side effects range from mild and easy to manage to serious, needing emergency treatment.

Breyanzi is used to treat several forms of non-Hodgkin lymphoma, such as large B-cell lymphoma (BCL) and chronic lymphocytic leukemia (CLL).

The treatment involves taking a person’s own white blood cells, genetically modifying them in a lab to spot cancer, and putting them back into the body to fight the disease. This is given as a one-time intravenous infusion (IV) in the hospital.

Although CAR T-cell therapy is effective, re-engineering the immune system can lead to a wide range of side effects. This article will explore the most common physical reactions, serious risks, and how to manage them.

Tips for managing the side effects of Breyanzi

After Breyanzi treatment, there are steps you can take to keep yourself safe:

  • Report side effects immediately: If you experience symptoms of CRS or neurological changes, contact your healthcare team immediately.
  • Take safety precautions: Avoid driving, operating heavy machinery, and other high risk activities for at least 2 weeks following Breyanzi treatment.
  • Stay close to care: Stay near the healthcare facility for at least 2 weeks after the infusion. This means you can be treated immediately if side effects develop.
  • Manage fatigue: Get plenty of rest after Breyanzi treatment. Ask your doctor about the types of physical activity you can do.
  • Avoid infections: Protect yourself from infections by avoiding crowds, washing hands often, and protecting against cuts and bruises. Your doctor may advise taking antibiotics or antiviral medications to prevent sickness while your blood counts recover.
  • Manage nausea: Eat small, frequent meals and avoid greasy, fatty, spicy, or acidic foods, such as lemons and tomatoes. A doctor may prescribe anti-nausea medication to help.
  • Carry the card: Your healthcare team will give you a Breyanzi patient wallet card that lists symptoms to watch out for that require emergency medical care. Carry this card with you at all times to show to health professionals.

The most common side effects of Breyanzi range from mild and easy to manage to serious and life threatening, requiring emergency medical treatment. If you have new symptoms that are difficult to manage, talk with your oncology team.

The most common side effects from Breyanzi include:

  • cytokine release syndrome (CRS)
  • fever
  • fatigue
  • encephalopathy (brain dysfunction)
  • body aches
  • nausea
  • headache
  • diarrhea
  • edema (swelling)
  • infection
  • decreased appetite
  • shortness of breath
  • hypotension (low blood pressure)
  • tachycardia (fast heart rate)
  • dizziness
  • constipation
  • tremor
  • cough
  • rash
  • abdominal pain
  • vomiting

Breyanzi can also cause decreases in blood cell counts, which are measured in a lab from blood samples. For more information, see the “other serious side effects” section below.

After the Food and Drug Administration (FDA) approves a drug, it tracks and reviews side effects of the medication. If you’d like to notify the FDA about a side effect you’ve had with Breyanzi, visit MedWatch.

The Food and Drug Administration (FDA) places a “boxed warning” on medications that have potential for very serious or fatal side effects. Breyanzi carries three warnings.

Cytokine release syndrome (CRS)

CRS is an inflammatory response in the body that occurs when the genetically modified T cells (CAR T cells) in Breyanzi bind to their target cancer cells. This binding causes the T cells to activate and multiply rapidly, releasing a wave of substances called pro-inflammatory cytokines into the blood.

Symptoms of CRS include high fever, chills, fast heartbeat, and difficulty breathing. CRS occurred in 56% of patients in clinical trials. While many cases are mild, CRS can be fatal if not treated. Doctors may use drugs like tocilizumab or corticosteroids to stop the reaction.

Brain toxicities

Breyanzi can affect the brain and nervous system. Symptoms might include confusion, difficulty speaking (aphasia), tremors, seizures, or loss of consciousness.

These brain-related side effects can happen at the same time as CRS or after it has resolved. These symptoms can be severe, so doctors monitor patients very closely for signs of “brain fog” or changes in mental state.

Secondary cancers

Breyanzi works by changing the genetics of cells, so there is a risk that the treatment itself could lead to new cancers later in life. T-cell cancers (blood cancers) have occurred in patients treated with this type of therapy. Doctors will monitor people for these secondary cancers for the rest of their lives.

Besides those covered by the boxed warning, Breyanzi can cause other complications that require medical intervention. They include:

  • Low blood cell counts (cytopenia): Breyanzi can lower the number of healthy blood cells in the body. This condition can last for several weeks after the infusion.
  • Low red blood cells (anemia): This leads to fatigue and weakness.
  • Low platelets (thrombocytopenia): This can cause easy bruising or bleeding.
  • Low white blood cells (neutropenia): This makes it much harder for the body to fight off germs.
  • Serious infections: The chemotherapy you have before Car T-cell therapy can lower white blood cell counts, so the immune system is temporarily weakened. This puts patients at high risk for life-threatening infections caused by bacteria, viruses, or fungi. In clinical trials, some people developed severe infections like pneumonia.
  • Low antibodies (hypogammaglobulinemia): Breyanzi targets B-cells (the cells that turn cancerous), but it can also destroy healthy B-cells that help make antibodies. This can lead to a condition where the body does not have enough antibodies (immunoglobulins) to fight infections, requiring some patients to receive replacement therapy.

If you experience the following symptoms after Breyanzi treatment, call a doctor or seek emergency help:

  • fever of 100.4°F (38°C) or higher
  • difficulty breathing or shortness of breath
  • dizziness or lightheadedness
  • chills or shaking chills
  • confusion or memory problems
  • difficulty speaking or slurred speech
  • severe nausea, vomiting, or diarrhea
  • fast or irregular heartbeat
  • severe fatigue or weakness

Breyanzi can help treat certain blood cancers, but side effects are possible.

The most common side effects include fever, fatigue, and body aches. Serious side effects include immune system overreactions, such as CRS, and neurological problems.

To manage these side effects, stay close to the hospital for the first few weeks and report symptoms like fever or confusion immediately.

Disclaimer: Healthline has made every effort to make certain that all information is factually correct, comprehensive, and up to date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or another healthcare professional before taking any medication.

The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.