Noopur Raje, MD, Marcela Maus, MD, PhD and Matthew Frigault, MD discuss the power and evolution of immune therapies, specifically, CAR T-Cell therapy in treating cancer.
Explore CAR T-Cell Therapies
What is CAR T-Cell Therapy?
In CAR T-cell cancer treatment, your blood is collected through a process called apheresis, sometimes called leukapheresis. This process separates your T-cells from the rest of your blood. The T-cells are then sent to a lab where they are engineered to attack B-cell lymphoma cells. The engineered T-cells are then multiplied and sent back to the hospital. Back in the hospital, the cells are reintroduced to your body through an IV infusion.
CAR T-cell therapy is a complex treatment that can cause severe side effects. Because of this, it is only given during a stay in the hospital. You will be carefully monitored by your treatment team for any side effects of CAR T-cell therapy. You will also be told about side effects and how to best care for yourself after you leave the hospital.
How CAR T-Cell Therapy Works
In CAR T-cell cancer treatment, a patient's own cells are modified in the lab to attack cancer cells in the blood. Once blood is removed from a patient, T-cells gain a special chimeric antigen receptor (CAR), which can bind to a protein on the cancer cells. Multiplied in the lab, the CAR T-cells are then reintroduced to the patient via blood infusion to attack cancerous cells.
What Cancers Can Be Treated with CAR T-Cell Therapy?
Mass General Cancer Center is an authorized treatment center for FDA approved CAR T-cell therapies for adult patients with lymphoma (Breyanzi, Kymriah, Tecartus and Yescarta) and for adult patients with multiple myeloma (Abecma).
CAR T-Cell Therapy for Lymphoma
CAR T-cell therapy for lymphoma offers a treatment option for some patients with non-Hodgkin lymphoma that has not responded to other therapies. CAR T-cell therapy has a targeted purpose and is designed for specific lymphoma, including large B-cell lymphoma, high-grade B-cell lymphoma, mediastinal large B-cell lymphoma, follicular lymphoma and mantle cell lymphoma. CAR T-cell treatment options for lymphoma include:
Breyanzi is FDA approved for the treatment of adult patients with relapsed or refractory large B-cell lymphoma after two or more lines of systemic therapy, including diffuse large B-cell lymphoma (DLBCL) not otherwise specified (including DLBCL arising from indolent lymphoma), high-grade B-cell lymphoma, primary mediastinal large B-cell lymphoma, and follicular lymphoma grade 3B.
Kymriah is FDA approved for adult patients with relapsed or refractory large B-cell lymphoma after two or more lines of systemic therapy including diffuse large B-cell lymphoma (DLBCL) not otherwise specified, high grade B-cell lymphoma and DLBCL arising from follicular lymphoma.
Tecartus is FDA approved for the treatment of adult patients with relapsed/refractory mantle cell lymphoma (r/r MCL).
Yescarta is FDA approved for adult patients with relapsed or refractory large B-cell lymphoma (DLBCL), primary mediastinal large B-cell lymphoma (PMBCL), high-grade B-cell lymphoma, and DLBCL arising from follicular lymphoma (transformed follicular lymphoma). Patients must have received two or more other forms of cancer treatment which did not successfully treat their cancer.
Yescarta is also FDA approved for adult patients with relapsed or refractory follicular lymphoma (FL) after two or more lines of systemic therapy.
Learn more about Mass General Cancer Center's Lymphoma treatment program.
CAR T-Cell Therapy for Multiple Myeloma
CAR T-cell therapy for multiple myeloma offers treatment for some patients with multiple myeloma that has not responded to other therapies. CAR T-cell multiple myeloma drugs are designed to attack cancer cells. The therapy is designed specifically to treat relapsed or refractory multiple myeloma.
Abecma was approved by the FDA in March 2021 for the treatment of adult patients with relapsed or refractory multiple myeloma after four or more prior lines of therapy including an immunomodulatory agent, a proteasome inhibitor, and an anti-CD38 monoclonal antibody.
Learn more about Mass General Cancer Center's Multiple Myeloma treatment program.
CAR T-Cell Therapy FAQs
Find updated information on CAR T-Cell immunotherapy for lymphoma and multiple myeloma. For more details, please refer to our brochure.
What Are T-cells?
T-cells are lymphocytes, which are a type of white blood cell. White blood cells fight infection.
What Is Immunotherapy?
Immunotherapy is a type of cancer treatment that uses the body’s immune system to find and attack cancer cells. CAR T-cell treatment is a type of immunotherapy.
What Does CAR T-Cell Therapy Treat?
CAR T-cell therapy offers treatment for some patients with non-Hodgkin lymphoma and multiple myeloma that has not responded to other therapies. Each therapy has a targeted purpose and was designed for a specific lymphoma or multiple myeloma.
What Are the Approved CAR T-Cell Therapies?
The FDA approved CAR T-cell therapies offered at Mass General Cancer Center include Breyanzi, Kymriah, Tecartus, Yescarta and Abecma. These therapies provide targeted treatment of B-cell lymphoma, high-grade B-cell lymphoma, mediastinal large B-cell lymphoma, follicular lymphoma, mantle cell lymphoma and multiple myeloma.
What Is Apheresis?
T-cells are collected from your blood by apheresis, a process that takes blood from the body and removes one or more blood components such as plasma, platelets or white blood cells. The remaining blood is then returned to the body.
What Is an Infusion Reaction?
An allergic response when the CAR T-cells are being infused into your blood. Your treatment team will monitor your vital signs and labs closely during your CAR T-cell infusion. You will also be given Tylenol and Benadryl before the CAR T-cell infusion to help stop a reaction.
How Long Will I Need to Stay in the Hospital?
Your hospital stay may range from one week to one month, or potentially longer. The length of stay depends on your body’s reaction to the CAR T-cell infusion and possible side effects.
What Are the Possible Side Effects of CAR T-Cell Therapy?
You will be very carefully monitored after your infusion for any side effects. Report any of these side effects to your treatment team immediately.
Possible side effects include:
- Cytokine release syndrome (CRS), which can include fevers, low blood pressure, low oxygen levels, fast heartbeat, confusion, and temporary kidney and liver abnormalities
- Neurologic toxicities, which can include confusion, excessive sleepiness, tremor, or seizures
- Decreased blood counts
- Increased risk of infection
- Swelling in hands, arms, feet, and legs
- Increased risk of bleeding
If you experience any of these side effects after you leave the hospital, call your treatment team right away:
- Excessive sleepiness
- Symptoms of infection
Family members are often the first to notice changes in behavior such as trouble remembering or confusion. Family members should report these changes to your treatment team.
What Is the Success Rate of CAR T-Cell Therapy?
CAR T-cell therapy has a verifiable track record of improving outcomes for patients when other treatments have not been successful. As treatment therapies improve, expect a continued success rate. Some studies show that up to 50% of patients treated with CAR T-cell therapies have found lasting remission with no additional treatment.
What Can I Expect Before My CAR T-Cell Infusion?
- You will have a medical and laboratory evaluation with a lymphoma specialist to determine if CAR T-cell therapy is right for you
- Your lymphoma will be re-staged with a PET-CT scan, if one has not been recently performed
- You will meet with a social worker to evaluate your psychosocial needs and determine the support we can provide you and your family
- You will undergo apheresis, a process where your blood is collected and processed to obtain the T-cells
- Before being admitted to the hospital, you will receive chemotherapy that is designed to prepare your body for the CAR T-cell infusion
- Your nurse will talk with you about your supportive care team members. You will meet with an oncology social worker. You have access to a nutritionist, spiritual care provider, or a member of the parenting at a challenging time (PACT) team at any period before, during and after your infusion
What Do I Need to Know For My Care After the Infusion?
- You should have someone living with you in your house for at least one month after your infusion
- You should avoid driving or operating heavy machinery for up to 2 months after your infusion
- You must live within 2 hours drive of the hospital for a month after your infusion
- You will need to set up a healthcare proxy, if you do not already have one. Your treatment team can provide you with a healthcare proxy form
- You will receive a patient wallet card and should carry it with you at all times. If you see a doctor, you should give this card to them
What Should I Do to Care for Myself After I Leave the Hospital?
Your treatment team will talk with you about how to care for yourself when you leave the hospital. They will give you specific information about personal care, mouth care, and hand washing. They can answer any other questions that you may have.
For more information about treatment with CAR T-cell immunotherapy for lymphoma, please refer to our brochure.
Learn more about CAR T-cell therapy in this series of videos.
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