Understanding Different Treatment Types: CAR T-Cell Therapy

What is CAR T Therapy? 

Chimeric Antigen Receptor (CAR) T-cell (T) therapy is a type of immunotherapy that uses your own T-cells to search out and destroy cancer cells. The T cells are part of your immune system that are responsible for killing off infected cells in your body and cancer cells.  

With CAR T-cell therapy, your T cells are modified to make them more effective in locating and destroying cancer cells. Currently, CAR T-Cell therapy is used to treat lymphomas, multiple myeloma, and some leukemias. 

What Should I Expect During CAR T Therapy?

  • Your T cells are collected using a process called apheresis. Apheresis is a procedure that withdraws blood from the body then sends it through a machine to remove the T cells before returning it back to the body.  

  • The T cells are then sent off to a lab where the T cells are turned into CAR T-cells. CAR T-cells are created by making the T cells produce a special protein (chimeric antigen receptor-CAR) on their surface. These CAR proteins are what cause the T cells to recognize and target cancer cells. 

  • The modified T cells are then multiplied until there is enough for treatment. They are frozen and sent to the facility where the treatment will be given.  

  • Most patients will be given chemotherapy before the CAR T-cells. This is done to decrease the chance of your body attacking or rejecting the CAR T cells. The frozen CAR T-cells are then thawed and infused into your blood stream. 

  • You will be monitored closely, either in the hospital or through frequent appointments with your doctor, for the first several weeks up to several months after treatment. This close observation is to make sure any complications and/or side effects are caught right away.  

What Are the Potential Side Effects and Complications?

Cytokine-Release Syndrome (CRS)- is the most common side effect occurring in 70-90% of patients. CRS occurs because the CAR T-cells are actively multiplying and killing cancer cells in the body. If this side effect happens, it usually around the second or third day after the infusion. 

  •  Mild symptoms of CRS: 

  • Severe symptoms of CRS: 

    • Changes to heart rhythm or blood pressure  

    • Low oxygen levels in the body and lungs 

    • Decreased kidney function 

    • Organ failure 

Immune effector cell-associated neurotoxicity syndrome (ICANS) - is brain and nerve toxicity that are the second most common complication with CAR T. This side effect is mostly seen between day four after infusion and up to three weeks later. 

This can cause a variety of symptoms: 

  • Confusion/hallucinations 

  • Difficulty speaking 

  • Muscle twitching/seizures 

  • Loss of consciousness 

Tumor Lysis Syndrome (TLS) is a condition that happens when a large number of cancer cells die very quickly. This side effect normally occurs during the beginning of treatment. Your medical team will monitor your labs closely for signs of this condition. 

Symptoms include: 

  • Nausea 

  • Lack of appetite 

  • Fatigue 

  • Heart palpitations 

  • Muscles cramps/spasms 

  • Numbness 

  • Hallucinations 

  • Seizures 

  • Decreased amount or darkening of urine 

  • Pain in the lower back 

What Should I Do If I Experience New Symptoms?

It will be important to communicate any new symptoms that you experience to your care team right away. Although side effects and complications can happen with CAR-T therapy, be assured that treatment and medications are available to manage these issues if they occur. Your care team will be made up of highly skilled experts in treating any problems that may arise.

It is important to discuss the benefits and the risks with your oncologist to decide if CAR-T therapy is right for you.