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More on Cellular Therapy

Cellular Therapy is the administration of cells as a living drug to treat disease.

Cellular therapy, also known as cellular immunotherapy for the involvement of the immune system in the mechanism of action, is one of the latest and greatest advances in medicine. In cancer medicine, the FDA has approved several cellular therapy products called CAR T-cells. These are T-cells from the patient that are genetically engineered to kill the patient's cancer cells . This has allowed us to save the life of patients with certain types of cancers like lymphomas and myelomas, without any other treatment options.

CAR T-Cell Therapy

One of the newest, most promising treatments for blood cancers is chimeric antigen receptor CAR T-cell therapy. These therapies use your body's own immune system to help fight cancer.

Certain immune system cells, called T-cells or T-lymphocytes, are normally able to identify abnormal cells, like cancer cells, and destroy them before they multiply and cause disease.

Unfortunately, T-cells can sometimes have trouble detecting and killing cancer cells. CAR T-cell therapy is the solution to this problem.

Using genetic engineering scientists can reprogram the DNA in T-cells from the patient, directing them specifically to certain types of cancer, and training them to kill these cells after they come in contact with them. In other words, genetic engineering transforms T-cells into cancer killers.

In 2017 the FDA approved CAR T-cell for some types of hematological cancers like leukemia and some lymphomas. A few years later it was also approved for multiple myeloma.

CAR T-cell therapy has the potential to change the survival outcome for tens of thousands of patients who failed all other treatment options.

Who Can Benefit from CAR T-Cell Therapy?

CAR T-cell therapy is available for some children with leukemia and some adults with lymphoma.

Children and Young Adults

CAR T-cell is recommended for those up to the age of 25 who have a type of leukemia called B-cell ALL. It will be used in one of the following situations:

Newly diagnosed children or young people whose leukemia hasn’t gone away with 2 cycles of treatment.
Their disease has come back (relapsed) following a stem cell or bone marrow transplant.
Their disease has relapsed twice or more.
Children and young adults whose leukemia had gone away with treatment, but it has come back, and chemotherapy isn’t working.
Their disease has come back once but they can’t have a stem cell transplant either because they aren’t well enough, or they don’t have a donor.

Adults

For adults, it will also be available for B-cell ALL and also patients with one of the following types of lymphoma:

Diffuse large B-cell lymphoma.
Primary mediastinal B-cell lymphoma.
Mantle cell lymphoma.

It is for those adults whose:

Diffuse B cell lymphoma or primary mediastinal lymphoma has continued to grow or relapsed following at least 2 treatments.
Mantle cell lymphoma has continued to grow or relapsed following treatment with a type of targeted drug called a Bruton’s tyrosine kinase inhibitor (e.g. ibrutinib).

The CAR T-Cell Therapy Process

01. Collection

The T-cells are collected from patients with certain types of cancers.

One tube removes the blood and passes it into an apheresis machine. The machine separates the different parts of the blood.

For CAR T-cell therapy, the machine takes out T-cells. The rest of the blood cells and normal blood fluid go back into the body through another tube in the other arm.

It can take 4 to 5 hours to collect patient T-cells.

02. Transduction

The T-cells are sent to special laboratories where they are infected with viruses in a process called transduction. The DNA of the virus is integrated into the DNA of the T-cell. The DNA of the virus contains the necessary information to transform the T-cell into a new form of cell called CAR T-cell, which is specifically trained to kill cancer cells.

03. Expansion

These CAR T-cells grow into hundreds of millions over a period of about 2 weeks. Meanwhile the doctors prepare the patient's body to receive the CAR T-cells. This is done with chemotherapy which prevents rejection of the CAR T-cells and helps the patient to "accept" them into their body. Doctors call this, lymphodepletion.

04. Infusion and Monitoring

After lymphodepletion and the patient's CAR T-cells have grown in sufficient numbers to kill cancer effectively, they are shipped from the lab to the hospital. The CAR T-cells are then infused intravenously, just like a blood transfusion. The doctors and nurses need to monitor patients closely for about 2 weeks after CAR T-cell therapy.

Patients either stay in hospital, hotel, or other residence nearby.

Healthcare teams usually recommend that patients are within a 30-minute drive from the treatment center for up to 28 days after the CAR T-cell infusion.

CAR T-Cell Therapy Side Effects

CAR T-cell therapy may cause some side effects or complications.

A serious complication of CAR T-cell therapy is cytokine release syndrome (CRS). CAR T-cells may release chemicals called cytokines, which causes a reaction from the immune system. Care teams have specialized treatments to manage this complication. Signs and symptoms may include:

Fever and chills
Dizziness, lightheadedness, or headaches
Fatigue
Pain in the muscles or joints
Nausea, vomiting, or diarrhea
Rapid heartbeat
Low blood pressure
Difficulty breathing

CAR T-cell therapy may also cause negative effects on the nervous system. Care teams can manage these complications with specialized treatments. These signs and symptoms may include: