What is it?
CAR T-cell therapy is a rare type of immunotherapy treatment in which T cells (a type of white blood cell) are extracted from the patient and combined with an artificial receptor, also known as a “chimeric antigen receptor.” When paired with the patient’s T-cells, this receptor enables the cells to produce chemicals that kill cancer. These are infused back into a patient’s body using an IV, where they begin to multiply and attack tumor cells.
The new therapy is offered to those who have failed the standard of care for diffuse large b-cell lymphoma and would otherwise have limited options for care. This therapy is a major breakthrough in the treatment of B-cell lymphoma and leukemia available in a select few cancer centers across the country, and only offered in Kentucky at the UK Markey Cancer Center through the Cell Therapy Program (CTP) in the Division of Hematology.
Step 1: Your T cells are removed through a blood draw.
To begin treatment, your blood is drawn and organized into blood cell groups by your doctors. Your T cells are then removed, while your other blood cells are returned to your body. This step typically takes two to three hours.
Step 2: T cells are prepared for treatment
After being drawn, your T cells are sent to a manufacturing site where they are modified to fit your best CAR T-cell therapy treatment. This may up to several weeks to complete.
Step 3: Develop CAR T-cells while preparing for infusion
Before receiving preliminary treatments, millions of CAR T-cells will be developed in order to be used for your treatment. About one week before you begin CAR T-cell therapy, you will receive low doses of standard chemotherapy in order to prepare your body for your new, programmed CAR T-cells. During this period, your doctor may also recommend other treatments to prepare for CAR T-cell therapy.
Step 4: CAR T-cell therapy infusion
At the hospital or clinic, you will receive your newly programmed T-cells by infusion. This process normally takes around one hour, but patients may need to remain in the hospital for a number of days in some cases. After being infused into your body, the T cells multiply and spread to find and attack the harmful cells.
Step 5: Monitoring for side effects
After your infusion, your doctor will monitor you closely for side effects which may require you stay in the hospital longer. Once your doctor feels it is safe, you will be allowed to return home. However, you may be asked to return if side effects begin to develop later.
To better understand the long-term results of your treatment, doctors will keep in touch with you for a period of time to measure the effectiveness of your treatment. The frequency of these follow-ups will be determined by your doctor.
The side effects of CAR T-cell therapy can range from mild to moderate in severity. These side effects are closely monitored by your doctors in order to prevent strong reactions to the treatment. In order to prevent two major side effects of CAR T-cell therapy, learn more about the symptoms below.
Cytokine Release Syndrome (CRS): CRS can develop within days to three weeks after your therapy treatment. Symptoms may include:
- Rapid heartbeat
- Muscle/joint pain
- Difficulty breathing
Neurotoxicity: Neurotoxicity can happen in the first few days to weeks after your CAR T-cells are returned to your body. Symptoms may include:
- Difficulty or inability to speak
- Difficulty staying awake
- Loss of coordination
- Rapid heartbeat
- Low oxygen level
- Blood cell count changes
If you experience any of the symptoms listed above following your treatment, tell your doctor so that they can best evaluate the symptoms.
Currently, CAR T-cell therapy products are only used for patients with adult B-cell non-Hodgkin’s lymphoma or childhood acute lymphoblastic leukemia who have been through two unsuccessful standard treatments.
However, the next phase of CAR T-cell therapy clinical trials aims to expand this treatment to indolent B-cell lymphoma, mantle cell lymphoma, multiple myeloma and acute myeloid leukemia.