Understanding CAR T therapy: What is it and when it might be right for you
Fact-checked by At some point in the course of myeloma treatment, doctors may recommend chimeric antigen receptor (CAR) T-cell therapy, a one-time cell therapy that’s used for cancer that has returned after (relapsed) or failed to respond to (refractory) earlier lines of treatment.
While CAR T-cell therapy can effectively control blood cancer growth, it is an involved process that comes with certain safety risks, and not everyone is eligible for the procedure. Before undergoing treatment, it is important to understand how CAR T-cell therapy works and how it might benefit you.
What is CAR T-cell therapy?
Simply put, CAR T-cell therapy for multiple myeloma helps your immune system more effectively destroy cancer cells. It is a so-called living drug because it is made from live, functional cells. It typically involves engineering your own T-cells — a class of immune cells with an innate ability to destroy abnormal cells — to make them specifically recognize and target myeloma.
This is accomplished by attaching a lab-made receptor protein, or CAR, to their surface that will bind to a protein on your cancer cells. This effectively programs your T-cells to locate and attack myeloma cells. Currently available CAR T-cell therapies belong to a class called BCMA-targeted therapy because they are designed to bind to a protein on myeloma cells that’s known as B-cell maturation antigen (BCMA).
CAR T-cell therapy can help achieve deep treatment responses, including minimal residual disease negativity, a state where the small number of cancer cells that can persist after treatment are undetectable. This can lead to longer periods of remission and extend your treatment-free interval — when you don’t need other myeloma therapies.
Still, it is also important to understand that CAR T-cell therapy is not a cure, and eventually, most people who receive it will still experience disease progression.
CAR T-cell therapy eligibility
In the U.S., CAR T-cell therapy is approved for people with relapsed or refractory multiple myeloma (RRMM). Depending on the specific product, you may be able to receive it after one or two prior lines of treatment.
If you are newly diagnosed with myeloma and have not yet received any treatment, you do not meet CAR T-cell eligibility criteria at this time.
There are no specific age restrictions for CAR T-cell therapy, but a doctor will always need to ensure your overall physical fitness and organ function are sufficient to undergo the procedure.
Treatment timeline
The first step in undergoing CAR T-cell therapy is to discuss with your healthcare team whether it is the right choice for you, and if so, when it makes sense to start the process. You may need to get new imaging scans and lab tests to see the state of your myeloma. You’ll also likely meet with a social worker to make sure you have the support you need.
Once it’s time for treatment, the entire process often takes a few months to complete. CAR T-cell therapy is always administered at an authorized treatment center with appropriate expertise. Generally, this involves:
- Cell collection (a few hours): T-cells are collected from your blood in a process known as apheresis. This process may need to be repeated more than once.
- CAR T-cell engineering (about a month): The cells are engineered in the lab, during which your doctor may prescribe other RRMM treatment options to control your myeloma. This is known as bridging therapy.
- Pretreatment (a few days): A short course of chemotherapy is given to prepare the body for treatment and make room for the CAR T-cells.
- CAR T-cell infusion (about an hour): The CAR T-cells are returned to your body intravenously, or as a single infusion into the bloodstream.
- Monitoring (one week or more):Â You might stay at the hospital for as long as a couple of weeks so you can be closely monitored for complications. Some people may be able to go home without a hospital stay.
When you go home after treatment, you’ll still need to be monitored regularly by your care team. Your doctors may advise you to live within a certain distance of the hospital and to have someone stay with you for a few weeks to a month after your infusion.
Managing side effects: What to watch for
CAR T-cell therapies can have serious or life-threatening side effects. As such, it is important to understand these risks before you undergo treatment.
Because of the need for careful monitoring, there are also caregiver requirements for those undergoing CAR T-cell therapy. You’ll need at least one trusted adult in good health who can keep a continuous eye on you and take you to appointments.
During or shortly after the infusion, an allergic reaction may occur. You’ll be given medications beforehand to prevent this, and carefully monitored for these reactions. In the days and weeks after your CAR T-cell infusion, there are some other safety concerns your doctors will monitor for. These include:
- Cytokine release syndrome (CRS): This is a systemic inflammatory response that most often occurs in the days, to as long as weeks, after treatment. Among the symptoms are fever, chills, breathing difficulties, nausea or vomiting, headaches, tiredness, rapid heart rate, or dizziness.
- Neurological complications: This can include an immune response called immune effector cell-associated neurotoxicity syndrome, known as ICANS. Typical symptoms are headaches, confusion, tremors, difficulty speaking, and movement problems.
- Low blood cell counts: Pretreatment chemotherapy can lower blood cell counts, increasing the risk of serious infections, fatigue, and bleeding complications.
You’ll likely be advised to avoid driving or operating heavy machinery for a couple of weeks after treatment in case complications arise. In the long-term, CAR T-cell therapy can also increase the risk of secondary blood cancers for some patients.
It’s important to discuss any potential side effects with your care team before receiving treatment so you know what to look out for. Report all side effects to your doctor right away, as there are often medicines and interventions that can help manage these complications.
Rare Cancer News is strictly a news and information website about the disease. It does not provide medical advice, diagnosis, or treatment. This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website.
