What Happens During CAR T-Cell Therapy
- CAR T-cell therapy is a lymphoma treatment that “trains” your own immune cells to treat cancer
- The immune cells are re-engineered in a lab to target lymphoma cells
- Careful monitoring is needed after treatment because of the side effect risk
Your immune system comes equipped with an army of white blood cells, called T cells, that normally protect it from infections and cancer. But sometimes, these cells miss their target. "The cells that help fight cancer unfortunately don’t recognize their own cancer anymore," Dr. Julie Vose, chief of hematology/oncology at the University of Nebraska Medical Center tells SurvivorNet. CAR T-cell therapy "helps to wake up those cells to be able to fight cancer."
Re-engineering Your Immune Cells
Read MoreThe CAR T cells are specific to your cancer. For example, some types of lymphoma cells have the antigen CD19 on their surface. CAR T-cell therapies for those cancer types only target the CD19 antigen.
A few days before the actual infusion, you'll get chemotherapy to clear out some of your own immune cells and prime your body to receive the CAR T cells. This will help the CAR T cells work better. Finally, the modified T cells will be infused back into your body to hunt down the cancer.
Careful Monitoring is Key
Treatment doesn't end once you've received the CAR T cell infusion. "They typically have to be monitored very carefully after that for a number of weeks or even months, due to some of the potential side effects," Dr. Vose says.
Those side effects come as a result of chemicals called cytokines, which are released into your blood as the activated CAR T cells multiply. A flood of cytokines can lead to a side effect known as cytokine release syndrome. Often it starts with flu-like symptoms a fever, chills, fatigue, appetite loss, nausea, and vomiting. The flood of cytokines can also cause nerve damage (neurotoxicity), which can present with symptoms such as:
- Headache
- Confusion
- Delirium (a disturbance in mental abilities)
- Changes in memory
- Language problems
- Tremors
This widespread immune response can cause inflammation in various organs and tissues around the body. In some people it can become very serious, causing low blood pressure, shortness of breath, and confusion.
Doctors check for these side effects and have treatments to manage them. People with very serious responses after CAR T-cell therapy may need treatment in a hospital.
Who Can Get CAR T-Cell Therapy?
As exciting as this treatment is, it’s not right for everyone with lymphoma. "It has been quite good specifically in patients with relapsed diffuse large B-cell lymphoma, the most common type of non-Hodgkin lymphoma," Dr. Vose tells SurvivorNet. CAR T-cell therapy is already FDA-approved for people with this type of lymphoma who have tried standard treatments without success.
CAR T-cell therapy is also in clinical trials for other types of non-Hodgkin lymphoma, as well as for Hodgkin lymphoma and chronic lymphocytic leukemia (CLL). These studies are very promising, but they’re still preliminary. Researchers are still trying to work out the right doses, and the right type of CAR T cell for each lymphoma. It's likely the treatment won't be available to people with these types of cancer for some time, Dr. Vose says.
Learn more about SurvivorNet's rigorous medical review process.
