CAR T-cell Basics

CAR T-cell therapy is a new treatment that uses the patient's own immune system to fight cancer.

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What is CAR T-cell Therapy?

Chimeric Antigen Receptor T-cell (CAR T-cell) therapy is a new approach to fighting cancer using the patient’s own immune system.

Certain immune system cells, called T-cells or T-lymphocytes, are normally able to identify abnormal cells, like cancer cells, and destroy them before they multiply and cause disease. Sometimes, however, T-cells have trouble detecting cancer cells.

CAR T-cell therapy removes T-cells from the blood and inserts a new gene into them to make it easier for the T-cells to fight cancer. The new cells are called CAR T-cells.

Millions of these CAR T-cells are created and then re-infused into the patient to fight cancer.

Video by American Society of Gene and Cell Therapy

Who can receive CAR T-cell therapy?

Five CAR T-cell therapies are currently approved by the U.S. Food and Drug Administration (FDA) for treatment of patients with certain diseases:

  • Kymriah® (tisagenlecleucel) for
    • children and young adults (up to 25 years old) with B-cell acute lymphoblastic leukemia (ALL)
    • adults with diffuse large B-cell lymphoma (DLBCL)
    • adults with transformed follicular lymphoma
  • Yescarta® (axicabtagene ciloleucel) for adults with
    • diffuse large B-cell lymphoma (DLBCL)
    •  primary mediastinal large B-cell lymphoma
    • high grade B-cell lymphoma
    • DLBCL arising from follicular lymphoma
    • relapsed or refractory follicular lymphoma
  • ​Tecartus® (brexucabtagene autoleucel)
    • ​adults with mantle cell lymphoma
    • adults with B-cell acute lymphoblastic leukemia (ALL)
  • Breyanzi® (lisocabtagene maraleucel; liso-cel)
    • adults with large B-cell lymphoma (LBCL)
  •  Abecma® ( idecabtagene vicleucel)
    • adults with multiple myeloma 
  • CARVYKTI™ (ciltacabtagene autoleucel)
    • adults with multiple myeloma

You may be eligible for one of these CAR T-cell therapies if, after several rounds of conventional treatment, your cancer came back or stopped responding to treatment.

Research is underway to determine if patients with other types of cancer can also be helped by CAR T-cell therapy.

How long does CAR T-cell therapy take?

There are several steps involved in CAR T therapy:

  • collecting your T-cells
  • converting your T-cells into CAR T-cells at a special laboratory
  • growing hundreds of millions of your CAR T-cells in the laboratory
  • preparing your body for the CAR T-cells, usually with chemotherapy
  • infusing the CAR T-cells into your body
  • monitoring you for complications after treatment

CAR T-cell therapy usually takes four-to-eight weeks from the collection of T-cells through follow-up care after the cells are infused. 

How are T-cells collected?

The process used to collect your T-cells is called leukapheresis. The collection usually takes place in the outpatient clinic and can take four-to-six hours.

During your T-cell collection:

  • you will sit in a comfortable chair or bed
  • blood will be withdrawn from you and passed through a machine that separates out your T-cells
  • the rest of your blood product will be returned to you

The T-cells are then sent to a special laboratory where they are genetically modified and turned into CAR T-cells that can destroy your cancer cells.

How long does it take for the laboratory to create the CAR T-cells?

It can take three-to-six weeks to create enough CAR T-cells for you. During that time, you will undergo a series of tests to confirm you are healthy enough for an infusion of CAR T-cells. These tests may include:

  • blood counts
  • tests for infection
  • pulmonary function tests to determine the health of your lungs
  • echocardiogram to assess your heart’s health
  • MRI to determine whether your disease has spread to the brain
  • blood tests to assess kidney and liver function
  • bone marrow tests
  • CT or PET/CT imaging to determine where the disease is located in your body
  • a biopsy to confirm your diagnosis
  • a spinal tap to determine if your disease has spread to your central nervous system

You may also have a consultation with a social worker to address any emotional concerns you have, as well as issues such as managing expenses, transportation, and lodging. Finding resources to help you pay for transportation and lodging is very important if you do not live close to the treatment center.

The social worker will also discuss the important role of your family member or friend who will serve as your caregiver. You may be invited to attend a class for CAR T-cell recipients and caregivers to help you better understand what to expect during and after treatment.

While your CAR T-cells are being created, your doctor may recommend that you have additional chemotherapy or radiation to prevent your disease from getting worse. Some patients are hospitalized for this treatment, while others can receive it in the outpatient clinic.

What happens when the CAR T-cells are given back to the patient?

man in bed with family at side and nurse hanging bag on iv pole

A few days before your CAR T-cells are infused into you, you will receive chemotherapy to prepare your body to receive the new cells.

This process is called lymphodepletion and may cause:

  • fatigue
  • low blood counts
  • nausea

The infusion of CAR T-cells usually takes place in the hospital where you can be carefully monitored. In some cases, the infusion takes place in the outpatient clinic.

You will be awake during the infusion. ​Your CAR T-cells will be returned to you much like a blood transfusion. ​The actual infusion typically takes 15-30 minutes.

Depending on which CAR T therapy you are receiving and whether complications develop after the infusion, you may need to remain in the hospital for several days or weeks.

Does CAR T-cell therapy cure cancer?

Although no one can predict with certainty whether CAR T-cell therapy will cure you of cancer, it has helped many patients.

CAR T-cell therapy may:

  • put you into complete remission (no evidence of disease) for many months or years
  • put you into remission for a short period of time before your disease comes back
  • put you into a partial remission (there is still evidence of disease, but the amount is less)
  • not put you into remission at all

In some cases, CAR T-cell therapy is used as a “bridge” to other treatments, like a stem cell transplant, to reduce the amount of disease in your body.

Talk to your doctor about how likely it is that CAR T-cell therapy will provide you with long-term health. Since your cancer may come back after CAR T-cell therapy, it is important that you are carefully monitored by your oncologist long-term.

Watch a video about CAR T-cell therapy

NEXT:  Preparing for CAR T-cell therapy​

Reviewed January, 2020 by Alix Beaupierre RN, BSN, OCN; Michael Bishop MD; Nelson Chao MD; Kevin J. Curran MD; Matthew Frigault MD; Ajay Gopal MD; Mark Juckett MD;  Navneet Majhail MD, MS; Kenneth Miller MD; Miguel-Angel Perales MD; Steven Pavletic MD, MS; Michael Pulsipher MD; Craig Sauter MD; John Wingard MD