Who is eligible for CAR T-cell therapy?
CAR T-cell therapy is not for when someone first develops cancer. It is used to treat cancers that have either returned after treatment or haven’t responded to standard treatments. The Food and Drug Administration (FDA) has approved CAR T-cell therapies for the following conditions.
In children:
- B-cell acute lymphoblastic leukemia
In adults:
How do CAR T cells work?
T cells are immune cells that can find and fight disease in the body. CAR T-cell therapies are designed to harness this power.
CAR T-cell therapies are made by genetically engineering a patient's T cells to make a protein called a chimeric antigen receptor (CAR). These receptors bind to specific proteins (called antigens) on the surface of the patient's cancer cells, like a key fitting into a lock. The CAR T cells then destroy the cancer cells.
Different cancers have different antigens, so each CAR T-cell therapy is specific to its cancer type.
Evaluation for CAR T-cell therapy
Your oncologist will work with you to determine whether you're a good candidate for a CAR T-cell therapy.
Since the CAR T cells are tailor-made for each patient, it takes about four to eight weeks to produce and receive the therapy. You must be healthy enough to wait that long. Your oncologist may need to run tests to determine your eligibility and ability to wait for treatment. In some cases, patients receive bridging therapy (treatments to control their cancer until the modified cells are ready).
Preparation for CAR T-cell therapy
You’ll need a trusted caregiver – or a team of rotating, dependable caregivers – who can be with you 24/7 for at least four weeks and potentially up to eight weeks after you receive your CAR T-cell therapy infusion and return home. Members of your caregiving team should:
- Be at least 18 years old
- Be in good health
- Be able to keep their time commitment
- Have backup people they can call if something makes them unable to be with you
- Be able to understand what is required of them
- Be able to observe any side effects you may develop
- Be able to provide emotional support
Your UCSF team will work with you to ensure that your caregiving team is well informed about what will be required of them.
Procedure for CAR T-cell therapy
CAR T-cell therapy is split into three main stages: the T-cell collection, the modification process and the infusion.
Step 1: Leukapheresis
To collect the T cells for modification, you’ll undergo a procedure called leukapheresis: Using IV lines, you're connected to a machine that collects blood from a vein, passes it through the machine to separate out the T cells, and returns the remaining components to your bloodstream. Your T cells are then sent to a highly specialized manufacturer for genetic modification.
Leukapheresis is an outpatient procedure, meaning you can go home the same day.
Step 2: Genetic modification
At the CAR T-cell manufacturer, your T cells are genetically modified to include chimeric antigen receptors (CARs) that match the antigens on your cancer cells. The manufacturer then grows millions of the modified T cells for your treatment. This process takes about three to six weeks.
About five days before your CAR T-cell infusion, you'll receive a treatment known as preconditioning or lymphodepleting chemotherapy. It uses specific drugs to reduce the number of immune cells in your body and make room for the modified cells.
You may also receive bridging therapy while waiting for your modified cells to be ready.
Step 3: Infusion
When your modified T cells are ready, they're shipped back to UCSF and reintroduced to your body by IV infusion. This will happen either in the hospital or an outpatient clinic, depending on the particular CAR T-cell therapy you’re having.
Short-term side effects of CAR T-cell therapy
For the first 30 days after your infusion, we will monitor you carefully for side effects. You may be in the hospital or at home during this period, depending on the specific CAR T-cell therapy you received.
While CAR T-cell therapy can be very effective for some hard-to-treat cancers, it can have serious and even life-threatening side effects. If you experience any of the side effects described below after your treatment, contact your medical team right away.
Cytokine release syndrome
Certain immunotherapy treatments, including CAR T-cell therapy, can set off this condition. It occurs when the modified cells cause large amounts of cytokines (a type of protein that affects the immune system) to be released into your bloodstream.
Signs of cytokine release syndrome include:
- Difficulty breathing
- Dizziness, lightheadedness or headaches
- Fatigue
- Fever and chills
- Low blood pressure
- Muscle or joint pain
- Nausea, vomiting or diarrhea
- Rapid heartbeat
Nervous system issues
CAR T-cell therapy can cause neurological side effects, including:
- Confusion
- Headaches
- Loss of balance
- Seizures
- Shaking or twitching (tremors)
- Trouble with speech and comprehension
Other possible side effects
Additional side effects may include:
- Allergic reactions to the infusion
- Decreased blood cell counts
- Easy bruising or bleeding
- Low potassium, sodium or phosphorus levels in the blood
- Severe infections because of a weakened immune system
Although it's rare, some patients experience long-term complications from CAR T-cell therapy. Your doctor will discuss these potential complications with you.
