CAR-T Cell Therapy

Procedure for CAR T-cell Therapy

CAR T-cell therapy involves the collection of a patient’s T cells through a process known as leukapheresis, where a machine extracts the blood and can simultaneously separate T cells. These T cells can then be transported to a lab where they will be cultured to produce CAR.

Then, these will be cultivated to produce millions of such CAR-T cells that can be re-injected into the patient. When inside the patient, it can then thrive and recognize the cancer cells. In some cases, while the CAR-T cells produce and reach the required number, the patient may be subjected to bridging therapy.

Bridging therapy subjects the patient to radiation or chemotherapy that helps manage the cancer while CAR-T cells are under production.

Before the Procedure

This involves the necessary steps to prepare for the surgery. It includes preparing the patient for the procedure through the following steps:

• Conducting patient evaluation

• Cell collection through leukapheresis

• Cell modification to prepare CAR T-cells

• Bridging therapy that includes chemotherapy or lymphodepletion to minimize the risk of body rejecting CAR T cells

After the Procedure

The procedure mainly involves reinjecting the CAR T cells after they’ve reached a substantial amount. After the infusion, close monitoring for side effects and health progress. The patients need to remain in the hospital for complete monitoring.

Follow-up appointments to keep a check on the cancer’s remission and any additional steps that may be necessary to maintain the patient’s health.

Types of CAR T-cell Therapy

Primarily, six types of CAR-T cell therapy exist, depending on the type of blood cancer. The following is a list of the currently FDA-approved therapies that are routinely used for the respective blood cancer type:

1. Kymriah: This is approved therapy for B-cell acute lymphoblastic leukemia, or ALL in cases involving children and young adults. It is also suitable for certain types of lymphoma. Also known as tisa-cel (tisagenlecleucel).

2. Tecartus: This is the CAR-T cell therapy approved for B-cell ALL in adults and mantle cell lymphoma. Also known as brexu-cel (brexucabtagene autoleucel).

3. Yescarta: The therapy is best suited for certain types of B-cell lymphomas, such as large B-cell lymphoma and follicular lymphoma. Also known as Axi-Cel (axicabtagene ciloleucel).

4. Breyanzi: FDA-approved therapy for large B-cell lymphoma. Also known as liso-cel (lisocabtagene maraleucel).

5. Abecma: CAR-T cell therapy type for treating multiple myeloma. Also known as ide-cel (idecabtagene vicleucel).

6. Carvykti: Treats multiple myeloma. Also known as cilta-cel (ciltacabtagene autoleucel).

Follow-up Care & Recovery

Recovery looks different due to individual factors and cancer type or stage. However, one of the most remarkable points to note is the recovery time, which can be 6 months or longer. In addition, due to the therapy being a living drug, the individual has long-lasting remission as the CAR-T cells continue recognizing and killing cancer cells, even if they come back.

Your follow-up care will somewhat look like this:

• The first few months will include regular hospital appointments

• Follow-up tests include blood tests and imaging scans (such as bone marrow biopsies, or PET scans)

• Regular consultation with the CAR-T team to assess organ function, blood counts and overall health

• Prescription medications for managing side effects and preventing infections may be necessary. In addition, you may need to continue medications for several months to ensure complete recovery.

• There may be a few driving restrictions due to the neurological changes.

• Long-term follow-up for any late-onset complications or cancer recurrence.

Risks & Benefits

The CAR-T cell therapy is one of the highly effective treatments for blood cancers, but it also poses several risks, such as the following:

• Neurological issues or ICANS.

• Cytokine release syndrome (one of the significant risks).

• Weakened immune system that can increase the risk of infections.

Side Effects to Look Out For:

• Headaches

• Confusion or agitation

• Changes in consciousness

• Twitching or shaking

• Loss of balance

• Trouble understanding or speaking

• Allergic reactions during infusion

• Low blood cell counts, which increase the risk of bruising, fatigue, infections, and bleeding.

Benefits of getting the treatment:

• Personalized approach as it leverages the patient’s immune system.

• Protects the healthy cells in comparison to traditional treatment options (chemotherapy, radiation.)

• More than 85% of the cases see complete remission.

• Improves quality of life and prolongs it.

• Short treatment time that’s least invasive.

• Long-term remission as CAR-T cells remain in the body for an extended time,, which can continue attacking cancer cells if they relapse.