CAR T-cell therapies for multiple myeloma
Fact-checked by Chimeric antigen receptor (CAR) T-cell therapy is a class of one-time treatments that are sometimes used to treat people with myeloma, particularly those whose cancer has returned after treatment (relapsed) or failed to respond to (refractory) initial treatment.
Myeloma is a blood cancer that arises when immune plasma cells grow out of control in the bone marrow. As a type of immunotherapy, CAR T-cell treatment helps the body’s own immune system more efficiently target and destroy these cancerous cells.
What are CAR T-cell therapies?
T-cells are a group of immune cells with an innate ability to recognize and destroy abnormal cells, including cancerous ones. However, cancers like myeloma often have ways to evade T-cells and make the process less effective.
Simply put, CAR T-cell therapies involve engineering a person’s T-cells to help them overcome these barriers and get the job done more effectively.
The approach typically involves collecting a patient’s own T-cells and engineering them in the lab to have a receptor protein, or CAR, on their surface that specifically recognizes and binds to a protein on the surface of cancer cells. When the T-cells are returned to the patient, they are now programmed to specifically bind to their target and initiate immune-mediated destruction of the cancer cells. The CAR T-cell treatment process generally involves a few steps:
- T-cell harvesting: T-cells are collected from a person’s blood over a few hours and sent out to a laboratory.
- T-cell engineering: The T-cells are genetically edited in the lab to express the CAR, and then multiplied. This whole process takes a few weeks.
- Lymphodepletion: For a few days before treatment, patients undergo a conditioning or lymphodepletion regimen. This involves administering chemotherapy medications to help prepare the body and make room for the engineered cells.
- CAR T-cell infusion: The engineered T-cells are returned to the body via an infusion given into the bloodstream. They’ll now seek out and kill the cancer cells.
- Monitoring: After the infusion, patients usually stay at or near the hospital for at least a week, where they’ll be monitored closely for potential side effects and complications.
The whole process may take a few months to complete. Once administered, CAR T-cells may stay active in the body for months to years.
CAR T-cell therapies for multiple myeloma
There are two CAR T-cell therapies approved in the U.S. for the treatment of myeloma:
Both therapies specifically target the B-cell maturation antigen protein on myeloma cells.
Given via a single infusion into the bloodstream, they are approved for certain adults with relapsed or refractory multiple myeloma who have already received other treatments. Carvykti is indicated for use after one prior line of therapy, while Abecma is indicated for use after two lines of therapy.
Side effects
The specific side effects of CAR T-cell therapy vary depending on the specific medication, but may include:
- fever or chills
- infections
- low blood pressure
- fast heart rate
- nausea or diarrhea
- headache
- neurological problems
- swelling
- shortness of breath
CAR T-cell therapies used for myeloma also come with warnings that they could cause more serious complications, including:
- cytokine release syndrome, a type of systemic inflammatory response
- neurological toxicity
- prolonged or recurrent low blood cell counts, which can cause bleeding or infections
- secondary blood cancers
- allergic reactions
Myeloma patients receiving CAR T-cell therapy are usually closely monitored for several weeks after their infusion. They’ll usually need to stay nearby to their healthcare facility and avoid driving for at least a week or two after the infusion in case complications arise.
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