The CAR T-Cell Therapy Process
- CAR T-cell therapy starts by collecting immune cells, called T cells
- Those cells are genetically altered in a lab to help them find cancer cells
- Then they’re returned to your body, where they’ll get to work treating your cancer
"It is exciting," Dr. Siddhartha Ganguly, director of the Lymphoma/Myeloma Program at University of Kansas, tells SurvivorNet. "But it is also overwhelming for the patients."
Read MoreStep 1: Collect the Cells
The first thing doctors do when one of their patients needs this treatment is to collect their T cells, called lymphocytes. These are the immune cells that help your body fight off foreign invaders such as germs or cancer. "We try to collect the lymphocytes as soon as possible, before any further chemotherapy is given," Dr. Ganguly says. Chemotherapy drugs can be toxic to these cells. The less exposure T cells have to chemotherapy, the stronger they'll be to fight the cancer. The way doctors collect the cells is called leukapheresis, and it works similar to a centrifuge. First, a member of your care team will attach a tube called a catheter into your arm or under your collarbone. You'll sit comfortably in a reclining chair, while your blood flows through the catheter.A machine will separate your lymphocytes out of your blood, and then return the rest of your blood (including red blood cells, platelets, and the liquid portion, called plasma) to you.
Step 2: To the Lab
Your immune cells then go to a laboratory, where the CAR T cells will be created. At the lab, your T cells are genetically altered to produce special receptors called chimeric antigen receptors on their surface. These receptors will allow the CAR T-cells to find cancer once they're back in your body.
The whole process of making CAR T cells and shipping them back to your doctor takes around 17 to 21 days, Dr. Ganguly says.
Step 3: Chemotherapy Time
Once your CAR T cells are ready, you’ll start on a type of chemotherapy called lymphodepletion chemotherapy. This will prepare your body to accept the new cells, and prevent your immune system from attacking them. You'll probably visit a clinic to get this treatment. Lymphodepletion chemotherapy is given for three days in a row.
Step 4: Get Your New Cells
Next, it's time to get your newly engineered T cells. That may happen in a hospital or in an outpatient facility, depending on the center where you’re being treated and the exact type of CAR T product you are receiving. "Right now we are admitting all our patients for CAR T to our cellular therapeutics unit. Usually the patients are there for seven to 10 days," Dr. Ganguly says.
The process is very similar to getting a blood transfusion. Once it's done, your doctor will wait and watch.
Step 5: Monitoring Your Progress
CAR T-cell therapy can cause side effects known as cytokine release syndrome or neurotoxicity (nerve damage), which can be serious in some people. Your doctor will carefully monitor you for symptoms, and treat you if you do develop them. Because these side effects can affect a number of different organs and systems, you may see doctors from several specialties, including a neurologist and a dermatologist.
If you do well, you should be able to go home within a week to 10 days, Dr. Ganguly tells SurvivorNet. But you're not finished just yet. You'll need to see your doctor at the clinic every day for the first couple of weeks after treatment, and then every other day for a while.
After about a month, your doctor will check on the status of your cancer with a CT or PET scan. Based on the results, you may then be able to go back to your regular cancer doctor. But you'll continue to get regular monitoring for a while, says Dr. Ganguly, to "make sure that the disease continues to respond."
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