CAR T-Cell Therapy

CAR-T cell therapy refers to chimeric antigen receptor T-cell therapy. It is an advanced cancer treatment that uses a patient’s own immune cells to identify and destroy cancer cells. It is mainly used for certain blood cancers when other treatments no…

What is CAR-T cell therapy?

Why is CAR-T cell therapy important?

Helps to control cancers that are difficult to treat
Improves survival in some patients
Offers a long-term cancer-free period in selected cases
Improves the quality of life when other treatments have failed

Which conditions are commonly treated with CAR-T cell therapy?

CAR-T cell therapy is mainly used for:

Certain types of blood cancer (Leukemia)
Cancer of the lymph glands (Lymphoma)
Cancer of plasma cells in the bone marrow (Multiple myeloma)

These cancers affect both adults and children. Leukemia is one of the most common childhood cancers worldwide.

Signs and symptoms of blood cancer

Fever or chills
Difficulty breathing
Frequent infections
Weight loss
Sudden confusion
Uncontrolled bleeding
Severe weakness
Bone pain or tenderness
Excessive sweating

Diagnosis and investigations

Doctors may perform several tests before recommending CAR-T cell therapy.

Common tests include:

Blood tests
Bone marrow examination
CT scan or PET scan
Biopsy

What patients should expect

These tests help doctors:

Confirm the type of cancer
Understand how advanced the disease is
Decide whether CAR-T cell therapy may help

Patients may need multiple hospital visits before treatment planning is completed

What is done in CAR-T cell therapy?

Doctors collect T-cells from the patient’s blood and change them in a laboratory so they can identify and attack cancer cells. These changed cells are then returned to the patient’s body. The goal is to help the immune system fight cancer more effectively.

Before the procedure

The healthcare team will reassess your overall health to ensure you are ready for treatment
Doctors will check for any active infections
A low-dose chemotherapy will be given for about 3 days before the CAR-T cell infusion
This is called lymphodepleting chemotherapy
Inform your healthcare team if you experience side effects such as nausea, fever, tiredness or weakness, as medications may help relieve these symptoms
After chemotherapy, you may have a short rest period before the CAR-T cell infusion

Step-by-step procedure

Collection of T-cells: Blood is taken through a process called leukapheresis, where immune cells are separated and collected

Laboratory change: The collected T-cells are genetically changed to create CAR-T cells that can identify cancer cells. The modified cells are multiplied in the laboratory over a few weeks

Bridging therapy: Patients may receive chemotherapy before the CAR-T cell therapy. Following chemotherapy, patients are usually given a few days to rest before the CAR-T cell infusion

CAR-T cell infusion: The CAR-T cells are given back into the patient through a vein, similar to a blood transfusion. The infusion is usually painless and patients remain awake during the procedure. It generally takes 30–90 minutes, though in some cases it may take as little as 15 minutes

Benefits and expected outcomes

CAR-T therapy has shown encouraging results in some patients with difficult-to-treat cancers.

Possible benefits are as follows:

The treatment duration is relatively short compared to other therapies
Many patients recover quickly after treatment
Patients achieve long-lasting remission (Decrease or complete stoppage of disease symptoms)
In some patients, the treatment can slow or stop cancer progression for many years
The benefits of CAR-T cell therapy may last for a long time

Risks and complications

Like all cancer treatments, CAR-T cell therapy can have side effects, which are as follows:

Cytokine release syndrome (An immune reaction that can cause fever and flu-like symptoms)
Neurological issues (Problems affecting the brain or nerves)
Tumour lysis syndrome (A condition caused by rapid breakdown of cancer cells in the body)
Allergic reactions
Low blood cell counts
Infection risk

When should patients contact a doctor?

Contact your healthcare team immediately if you experience:

Persistent fever or chills
Severe headache
Difficulty breathing
Confusion or difficulty speaking
Severe weakness or dizziness
Persistent nausea or vomiting
Seizures or unusual sleepiness

Myths and Facts

Myth 1: CAR T is used only after all other treatments have failed

Fact: CAR-T therapy is not only used as a last-option treatment. It is increasingly being offered earlier during the course of the disease in suitable patients

Myth 2: CAR T-cell therapy replaces a stem cell transplant

Fact: CAR-T therapy may be an option for patients who cannot undergo a stem cell transplant. In some cases, patients may receive both CAR-T therapy and a stem cell transplant.

Myth 3: The side effects of CAR-T therapy can be serious and may require close medical monitoring and management

Fact: Although CAR-T cell therapy can cause serious side effects, doctors now have better experience in identifying and managing them

FAQs

Who is a candidate for CAR T-cell therapy?

Answer: CAR-T cell therapy is currently used for certain types of lymphoma, leukemia, and multiple myeloma in adults. It is usually recommended for patients whose cancer has returned or has not responded to at least two previous treatments.

Is there an age limit for CAR T-cell therapy?

Answer: Older age alone does not prevent patients from receiving CAR-T cell therapy and studies have shown that the treatment can be safe and effective in older adults.