What is CAR-T cell therapy?
CAR-T (chimeric antigen receptor) cell therapy uses a patient’s own immune system to fight their cancer. T-cells are cells in the blood that seek out and destroy abnormal cells such as cancer and bacteria. Their main job is to protect the patient from these abnormal invaders. The patient’s T-cells are collected from the blood and sent to a lab to be re-programmed to attack specific cancer cells.
The process used in the lab causes the cells to develop chimeric antigen receptors (CARs) on the outside of the cell. Then those cells are infused back into the patient and they identify and kill the cancer cells that fit those receptors.
CAR-T cell therapy is approved by the FDA to treat non-Hodgkin’s lymphoma that has relapsed or not responded to other treatments as well as for pediatric acute lymphoblastic leukemia. There are also many clinical trials being conducted using CAR-T cell therapy in other cancers.
Who is a candidate for CAR-T cell therapy?
The currently approved indications for CAR-T cell therapy are relapsed, refractory non-Hodgkin’s lymphoma and pediatric acute lymphoblastic lymphoma (up to age 25). Other diagnoses are being evaluated by various clinical trials around the world.
Where can I receive CAR-T cell therapy?
CAR-T cell therapy is only available at certain centers across the country. Certification by the manufacturer ensures that the center administering the therapy has special expertise in treating blood cancers with immune therapies.
Benefits of CAR-T cell therapy
The immune cells used in CAR-T cell therapy are T-cells. These cells are modified in the lab and then out back into a patient’s body and they can multiply into thousands of new ones. These cells stay in the patient’s body and keep killing the cancer cells.
Risks of CAR-T cell therapy
The side effects related to CAR-T therapy can be serious. Patients don’t lose their hair and have significant nausea and vomiting like they might with traditional chemotherapy. Treatment of these side effects usually requires admission to the hospital and may even require being cared for in the intensive care unit. Complications are usually temporary and respond to treatment with other medications. Our nurses and physicians receive special training to be able to identify and treat these side effects.
Side effects can include:
Cytokine Release Syndrome
Symptoms can range from mild to severe and are caused by the T-cells triggering an inflammatory response. This usually happens within the first few days after receiving the T-cells but can happen later.
- Difficulty breathing
- Fever (100.4°F/38°C or higher)
- Chills/shaking chills
- Severe nausea, vomiting, diarrhea
- Severe muscle or joint pain
- Very low blood pressure
- Dizziness/lightheadedness
Neurological Toxicities
These symptoms can occur anywhere from a week to several weeks after infusion. Because of the chance of these side effects patients are not allowed to drive or operate heavy machinery for 8 weeks after receiving T-cells.
- Altered or decreased consciousness
- Delirium
- Confusion
- Agitation
- Seizures
- Difficulty speaking and understanding
- Loss of balance
Other side effects include allergic reactions, low blood cell counts, serious infections, hypogammaglobulinemia (the levels of immunoglobulins in your blood may be low and lead to an increased risk of infection), and development of secondary cancers.
Your medical team is specially trained to deal with all these side effects and will monitor you closely for them.
What to expect during CAR-T cell therapy
CAR-T cell therapy is a process involving several phases:
Evaluation
Tests and screening to make sure you are eligible for CAR-T cell therapy.
Collection
Cells are collected from your blood stream through a process called apheresis. A central line catheter is used to collect the needed cells and the cells not needed for CAR-T are returned to you through the central line. This happens in the outpatient infusion area at the hospital.
Manufacturing
The cells are sent to a lab where they re-engineer them by adding a chimeric antigen receptors (CARs) on the surface of the cells. The CARs enable the T-cells to “see” the specific antigens on the cancer cells. These re-engineered cells are grown in the lab until there are enough of them to send back to the patient (usually several million).
Lymphodepleting chemotherapy
This is given in order to create space in the marrow for the CAR-T cells to land in and grow.
Infusion
The CAR-T cells are infused back into the patient much like a regular blood transfusion. If they have been frozen for storage and transport they will be thawed at the bedside and reinfused. It takes about 30 minutes to complete the infusion. Patients may be followed either in the hospital or in the outpatient department depending on their situation and the side effects they experience.
Recovery from CAR-T cell therapy
It takes a while for the CAR-T cells to get into the bone marrow and start growing. During this time patients must be followed closely for at least the first 30 days. If the patient isn’t admitted to the hospital they must be within an hour of the hospital so they can get here quickly if they develop and side effects. Our team will work with you to find you a place close by if you live too far away.