CAR T-cell therapy is a type of cancer treatment that harnesses the body’s own immune system to combat malignant cells. This therapy involves modifying a patient’s immune cells to recognize and destroy cancer. It offers a personalized strategy to target specific cancer cells while aiming to preserve healthy tissues.
Understanding CAR T-Cell Therapy
T-cells, a type of white blood cell, are natural components of the immune system that identify and eliminate abnormal cells. In CAR T-cell therapy, these T-cells are collected from the patient’s bloodstream through a procedure called apheresis. Blood is drawn, T-cells are separated, and the remaining blood is returned to the patient.
Once collected, the T-cells are sent to a specialized laboratory for genetic modification. Scientists introduce a new gene into the T-cells, enabling them to produce Chimeric Antigen Receptors (CARs) on their surface. These CARs recognize and bind to specific proteins, called antigens, found on cancer cells. After modification, the engineered CAR T-cells are multiplied in the lab to generate millions of these specialized cells. Once ready, they are frozen and transported back to the hospital for treatment.
CAR T-Cell Therapy’s Role in Lymphoma
CAR T-cell therapy is used for certain types of lymphoma, especially when conventional therapies have been unsuccessful or the cancer has returned. It is commonly used for aggressive B-cell non-Hodgkin lymphomas, including diffuse large B-cell lymphoma (DLBCL), mantle cell lymphoma (MCL), and follicular lymphoma (FL). The therapy specifically targets the CD19 protein, found on the surface of many lymphoma cells.
When CAR T-cells are infused, their engineered CARs attach to the CD19 antigen on lymphoma cells. This binding activates the CAR T-cells, prompting them to destroy cancerous cells and trigger an immune response against the lymphoma.
CAR T-cell therapy is considered for patients with relapsed or refractory lymphoma, meaning the cancer has returned after initial treatment or has not responded to prior therapies.
The CAR T-Cell Therapy Journey
The CAR T-cell therapy journey is a multi-step process requiring close coordination from a specialized healthcare team. It begins with an initial evaluation to determine eligibility, assessing overall health and lymphoma characteristics.
The first step is apheresis, collecting the patient’s T-cells. After collection, T-cells are shipped to a specialized manufacturing facility. Here, they are genetically modified to express CARs and expanded in number. While CAR T-cells are manufactured, patients may receive “bridging therapy” to manage their lymphoma.
Once ready, CAR T-cells are sent back to the hospital. Before infusion, patients receive conditioning chemotherapy to reduce existing immune cells and create space for the infused CAR T-cells to function effectively. Patients are then closely monitored to manage potential side effects.
Managing Potential Side Effects
CAR T-cell therapy can trigger side effects as activated immune cells interact with the body. The most common and serious are Cytokine Release Syndrome (CRS) and Immune Effector Cell-Associated Neurotoxicity Syndrome (ICANS).
Cytokine Release Syndrome (CRS) is a systemic inflammatory response caused by the release of cytokines from activated CAR T-cells. Symptoms include fever, chills, low blood pressure, difficulty breathing, and headache. CRS typically develops within the first 14 days after infusion. Management involves supportive care, such as intravenous fluids, and medications like tocilizumab or corticosteroids for severe cases.
Immune Effector Cell-Associated Neurotoxicity Syndrome (ICANS) involves neurological symptoms after CAR T-cell infusion. These symptoms range from confusion, difficulty speaking, and tremors to seizures or difficulty staying awake. ICANS can manifest from the first few days to several weeks post-infusion. Management involves corticosteroids and supportive care, with close neurological monitoring.