Who Can Benefit from CAR T-Cell Therapy?
The Food and Drug Administration has approved CAR T-cell therapy for patients with relapsed and treatment-resistant B-cell blood cancers who haven’t responded well to other cancer treatments.
These cancers include:
- B-cell acute lymphoblastic leukemia (B-ALL) for patients up to age 26 (second relapse or later)
- Diffuse large B-cell lymphoma for patients older than 18
Clinical trials using CAR T cells are also available for people with some other forms of blood cancer.
CAR T-Cell Therapy Treatment Steps
CAR T-cell therapy happens in the hospital. It is an inpatient treatment. Patients should expect to be in the hospital up to four weeks for treatment and observation.
Treatment steps include:
- Collection: The care team collects some white blood cells (including T-cells) from the patient.
- Modification: The care team sends the collected cells to an outside laboratory. In the lab, the T-cells are taught to grow special receptors on their surface, called chimeric antigen receptors (CAR) that help T-cells spot and attach to cancer cells.
- Multiplication: The new CAR T-cells multiply in the lab, are frozen, and are then returned to the hospital.
- Chemotherapy: Patients receive conditioning chemotherapy (lymphodepletion) a few days before treatment to make room for the CAR T cells to work.
- Infusion: The CAR T-cells are infused into the patient’s blood in one infusion.
The CAR T-cells target a specific protein called CD19 that is on the surface of B-cell cancers. If all goes as planned, the CAR T-cells continue to multiply in the patient's body and kill cancer cells that have the CD19 protein on their surfaces.
Finding a Hospital That Provides CAR T-Cell Therapy
CAR T-cell therapy is a highly specialized and personalized treatment that is only available at a small number of hospitals. Cincinnati Children’s has extensive CAR T-cell therapy experience. It was one of the first pediatric hospitals to offer CAR T-cell therapy clinical trials.
CAR T-Cell Therapy Benefits
Until recently, patients with relapsed or treatment-resistant B-cell blood cancers had very few treatment options. CAR T-cell therapy offers new hope. For example, in clinical studies, 62% of patients who had the CAR T-cell therapy using a drug called KYMRIAH were in remission two years post-treatment.
CAR T-cell therapy can be a game changer when standard treatment is not working. But it isn’t for everyone. The doctor will discuss the options with you before making a recommendation about whether this therapy or another advanced cancer treatment is the best option.
CAR T-Cell Therapy Risks
CAR T-cell therapy may have side effects. Some side effects can be serious but usually go away in a few days without long-term problems. These side effects include cytokine release syndrome (CRS), which causes flu-like symptoms and neurologic problems like confusion. A hospital stay is necessary to allow the care team to watch patients for serious side effects and provide early treatment if needed. About 30% of patients who have CAR T-cell therapy are admitted to the intensive care unit to be more closely monitored.
CAR T-Cell Therapy Recovery
The recovery time for CAR T-cell therapy is much shorter and less intense than it is for a bone marrow transplant. Most patients return to their normal lives within a month or two. A doctor will continue to monitor them for side effects and treatment response.
Many patients need long-term immunoglobulin replacement therapy (infusions) after CAR T-cell therapy to help boost their immune system.