Referring for CAR T-Cell Therapy
Below are guidelines we use to assess patients for CAR T-cell therapy as standard care. Additional criteria may apply for clinical trials:
CAR T for Lymphoma
Aggressive non-Hodgkin Lymphoma
- Confirmed diagnosis of DLBCL, primary mediastinal large B-cell lymphoma, high-grade B-cell lymphoma, or transformed follicular lymphoma to DLBCL that has relapsed or not responded to at least two prior lines of systemic therapy, if the initial response to first-line therapy was longer than 12 months. Patients with these diagnoses who do not achieve remission or relapse within 12 months of first-line therapy are eligible for CAR T as a second-line therapy.
Mantle Cell Lymphoma
- Histologically confirmed diagnosis of mantle cell lymphoma that has either not responded to, or relapsed after first line of therapy.
Follicular Lymphoma
- Confirmed diagnosis of follicular lymphoma that has relapsed or not responded to at least two prior lines of systemic therapy.
CAR T for Leukemia
- Confirmed diagnosis of B-cell acute lymphoblastic leukemia (ALL) that has either not responded or relapsed after at least two lines of prior treatment.
- Adequate organ, cardiac, and pulmonary function (must meet established criteria/measures).
CAR T for Multiple Myeloma
- Confirmed diagnosis of multiple myeloma that has relapsed or not responded (refractory) after four or more prior lines of treatment.
- Prior therapy must have included a proteasome inhibitor, an immunomodulatory drug, and an anti-CD 38 monoclonal antibody.
Preparing Patients for CAR T-Cell Therapy
While CAR T-cell therapy is a promising treatment, it is also a complex, lengthy process with the risk of serious side effects. It is important that you and your patients understand:
- Once CAR T-cell therapy is determined to be appropriate treatment, we collect the patient's T cells through leukapheresis. The T cells are then sent to a lab, either at Dana-Farber or off-site, to be engineered to express the target specific for the
patient's cancer. This manufacturing process generally takes two to three weeks.
- Patients may receive lymphodepleting chemotherapy in the days prior to their CAR T-cell infusion, to make room in their immune system for the CAR T cells to expand and proliferate.
- Most patients are hospitalized for one to three weeks to monitor for side effects. Some patients may receive their CAR T cells in the outpatient clinic and be monitored for 14 days in the outpatient setting.
- Potential serious side effects may include fevers, chills, low blood pressure, difficulty breathing, confusion, difficulty speaking or understanding language, or stupor. Our teams are specially trained to address these side effects, though patients
may be quite ill for a period of time while in the hospital.
- Patients must remain within two hours of Dana-Farber Brigham Cancer Center for 30 days after their CAR T-cell infusion for rapid management of side effects after discharge. A caregiver is required to stay with the patient during this period.
Working Together
We welcome the opportunity to discuss patients for whom CAR T-cell therapy may be appropriate. Contact us at 877-801-2278 or cartinquiries@dfci.harvard.edu.
Our team works collaboratively with referring oncologists after CAR T-cell therapy. We provide guidance on what to watch for, and recommended follow-up care. To monitor the long-term effectiveness of CAR T-cell therapy, patients will require follow-up
care for up to 15 years.