Cellular Therapies Program

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

What types of cancer are treated by CAR T-cell therapy?

Currently, CAR T-cell therapy is FDA approved as standard of care for:

• Some forms of aggressive, relapsed or refractory non-Hodgkin lymphoma including diffuse large B cell lymphoma, primary mediastinal B-cell lymphoma, high grade B-cell lymphoma, transformed follicular lymphoma, mantle cell lymphoma
• Relapsed or refractory follicular lymphoma
• Relapsed or refractory multiple myeloma
• Relapsed or refractory acute lymphoblastic leukemia
  

There are also many clinical trials of CAR T-cell therapy for other types of blood cancer and solid tumors.

For adult patients, call 877-801-CART (2278).
For pediatric ALL patients, call 617-632-5064 or email gene.therapy@childrens.harvard.edu.

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 Dana-Farber Brigham Cancer Center 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?

Coverage is reviewed on a case-by-case basis, as is typical for new therapies. 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 monitored closely to 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:

1. Evaluation: Patients undergo a series of tests and screenings to determine if CAR T-cell therapy is an appropriate option.
2. Collection: T cells are collected from patients via apheresis, a process that withdraws blood from the body and moves through a cell separator to collect the needed blood components, in this case, T cells. The remaining blood is then returned into the body. The procedure is done in one day in the outpatient clinic at the Kraft Family Blood Donor Center at Dana-Farber Cancer Institute and Brigham and Women's Hospital.
3. Engineering: The T cells are sent to a laboratory where they are genetically engineered to target a specific type of cancer.
4. 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.
5. 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.
6. Infusion: When the CAR T cells are ready, the cells are infused through a central line, in a process similar to a blood transfusion. Patients may receive medications to prevent and control possible side effects of the newly-engineered cells. Patients may receive their CAR T cells in the hospital or in the outpatient clinic. The patient's physician will decide which approach is best.
7. 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 admitted to the hospital during this period to manage complications. During the first 30 days after CAR T-cell infusion, 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 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.