How Do Doctors Determine Which Multiple Myeloma Patients Receive CAR T-Cell Therapy? What Challenges Do They Face?

What is CAR T-Cell Therapy and How Does it Work?

Our immune system was designed to fight off foreign invaders such as viruses, bacteria and yes, cancer. Sometimes, cancer cells can evade detection and continue to grow. But CAR T-cell therapy essentially re-trains your immune system to make it a more efficient, and more effective, cancer fighter.

The process starts when your doctor intravenously removes a sample of your blood. With a procedure called leukapheresis the removal of blood to collect specific blood cells your blood flows into a machine that separates out the T cells; it then returns the other blood components, such as red blood cells, platelets, etc.

The T cells are then sent out to a lab, where technicians insert an anti-cancer gene into them. That new gene causes special receptors called chimeric antigen receptors to pop up on the surface of the T cells. Those receptors are like homing devices that will lock onto the matching antigen on the surface of your cancer cells.

Once the T cells are back from the lab, you will first need treatment to prepare your body to receive the new, genetically modified T cells.

"I think, personally, CAR T-cell therapy is more like what you think a transplant is than an autologous (stem cell) transplant because autologous transplant really has no what we call graft versus tumor effect," Dr. Kazandjian tells SurvivorNet. "It's basically a rescue of your own cells."

How Do Doctors Determine Which Patients Get This Treatment?

The question of how doctors determine which multiple myeloma patients receive CAR T-cell therapy is somewhat answered for them by U.S. Food and Drug Administration approval guidelines, as well as accessibility.

The first CAR T-cell therapy for myeloma patients, idecabtagene vicleucel (brand name: Abecma), was approved by the FDA in March 2021. But there is a bit of a catch as to who can get this treatment.

RELATED: The Future for CAR T-Cell Therapy

The FDA approved Abecma for use in patients who have already been treated with at least four previous lines of therapy, as well as patients who either did not respond to the treatment (refractory myeloma), or initially responded but then had their cancer return (relapsing myeloma). These parameters eliminate newly diagnosed patients, as they have only begun their treatment regimen.

Dr. Kazandjian says that CAR T is "definitely a modality that's important in myeloma and, at least in the near future, it's here to stay, for the short term."

"We'll see in the longer term where it goes," he adds.

Facing Challenges Getting Patients CAR T-Cell Treatments

Dr. Kazandjian says he has had a "very bad" experience getting CAR T-cell therapy for his patients.

"It's just not available," he says. "I don't think I'm the only one. I think most physicians, even at myeloma centers like ours (in Miami), are having difficulty (with access to CAR T-cell therapy)."

There are only a handful of facilities who manufacture CAR T cells, which also limits the resources available, as well as narrows the pool of patients who are high enough priority to get this treatment.

"I have patients who come and … sometimes they even meet with our cellular therapy folks, but it's not happening. And hopefully that will change."

"I'm trying to open a couple of CAR T (clinical) trials with our colleagues and hopefully those will go smoothly to at least make those available," Dr. Kazandjian adds. "But the problem is at least of the FDA-approved drugs, they're just not around."

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