What is CAR T-cell therapy?
CAR T-cell therapy is a form of immunotherapy that uses specially altered T cells — a part of the immune system — to fight cancer. A sample of a patient's T cells are collected from the blood, then modified to produce special structures called chimeric
antigen receptors (CARs) on their surface. When these CAR T cells are reinfused into the patient, the new receptors enable them to latch onto a specific antigen on the patient's tumor cells and kill them.
Read more about how CAR T-cell therapy works
Who is eligible to receive CAR T-cell therapy?
Currently, CAR T-cell therapy is FDA approved as standard of care for some forms of aggressive, refractory non-Hodgkin lymphoma and for patients with relapsed or refractory acute lymphoblastic leukemia up to age 25.
In addition, there are many ongoing trials of CAR T-cell therapy for other forms of blood cancer. As a first step, ask your physician for a referral to our center for evaluation for CAR T-cell therapy. All patients must have a physician referral.
For adult patients, call 877-801-CART (2278) or email firstname.lastname@example.org.
For pediatric patients, call 617-632-5064 or email email@example.com.
Read more about whether CAR T-cell therapy is right for you
Where is CAR T-cell therapy available?
Because this is a highly specialized, highly personalized treatment, CAR T-cell therapy is available at a limited number of cancer centers with specialized expertise in cellular therapies. Both DF/BWCC and Dana-Farber Boston Children's Cancer and Blood
Disorder Center offer the FDA-approved CAR T-cell therapy as well as CAR T clinical trials.
Will my insurance cover CAR T-cell therapy?
Health insurers are preparing their coverage policies for the FDA-approved therapies. In the meantime, coverage is reviewed on a case-by-case basis as is typical when new therapies are first approved. We work with patients and insurers to seek health
insurance coverage for clinically-eligible patients.
What are the possible side effects of CAR T-cell therapy?
Although most patients do not experience the common side effects associated with chemotherapy such as hair loss, nausea, and vomiting, there are risks of significant side effects with CAR T-cell therapy. Patients are admitted to the hospital for several
weeks so our care team can monitor response to the treatment, and manage reactions to this therapy. The complications are generally temporary and resolve with treatment. Our care team is specially trained to identify and manage these side effects.
Possible side effects from CAR T-cell therapy include:
- Cytokine release syndrome: CAR T cells can initiate a massive release of substances called cytokines, which triggers an inflammatory condition known as cytokine-release syndrome (CRS). Symptoms may be flu-like, with a high fever and/or
chills; low blood pressure; difficulty breathing; or confusion. These symptoms can be mild or severe.
- Neurologic difficulties: Patients may also experience confusion, difficulty understanding language and speaking, or stupor.
Read more about potential side effects of CAR T-cell therapy
What is the treatment process for patients?
The treatment process involves:
- Evaluation: Patients undergo a series of tests and screenings to determine if CAR T-cell therapy is an appropriate option.
- Collection: T cells are collected from patients via apheresis, a process that withdraws blood from the body and removes one or more blood components (in this case, T cells). The remaining blood is then returned into the body. The
process takes place at the Kraft Family Blood Donor Center at Dana-Farber Cancer Institute and Brigham and Women's Hospital.
- Engineering: The T cells are sent to a laboratory where they are genetically engineered to express chimeric antigen receptors (CARs) on their surface. CARs are proteins that allow the T cells to recognize an antigen on targeted tumor
- Multiplication: The genetically modified T cells are "expanded" by growing cells in the laboratory until there are millions of them. This process can take a few weeks. When there are enough CAR T cells, they are frozen and sent to
the hospital or center where the patient is being treated. At our center, these cells are returned and processed at Dana-Farber's Connell and O'Reilly Families Cell Manipulation Core Facility.
- Conditioning Therapy: Prior to infusion of the CAR T cells, patients may receive chemotherapy for their cancer. This helps to create space in your immune system for the infused CAR T cells to expand and proliferate.
- Infusion: Soon after chemotherapy, patients are admitted to the hospital and the CAR T cells are re-infused in a process similar to a blood transfusion. This is a one-time infusion, although patients may remain in the hospital for
several weeks to monitor response to treatment, overall condition, and side effects.
- Recovery: Patients who receive CAR T-cell therapy have a risk/recovery period of approximately 2-3 months. During this period, patients will be evaluated for side effects and treatment response. It is not uncommon for patients to
be re-admitted to the hospital during this period to manage complications. During the first 30 days after discharge from the hospital, patients need to remain close to our center for regular follow-up care. A resource specialist can assist in
arranging for a place to stay during this time, if needed.
What does the recovery process entail?
Recovery can take time as your immune system recovers. The acute recovery period is typically for 30 days after the CAR T-cell infusion. During this time, patients must remain within two hours of Dana-Farber/Brigham and Women's Cancer Center, and must
have a caregiver with them at all times to monitor for signs of fever, infection, and neurologic difficulties. Most patients feel tired and don't have much appetite during this period.
What types of cancer can be treated by CAR T-cell therapy?
The FDA has approved CAR T-cell therapy for adult patients with certain types of lymphoma and for children and young adults with acute lymphoblastic leukemia who haven't responded to other forms of treatment. We are conducting clinical trials of CAR T-cell therapy for other types of blood cancer. Researchers are also starting to explore CAR T-cell therapy for solid tumors.