CAR-T cell therapy

CAR-T immunotherapy is a new and advanced form of treatment for cancer, offering hope and significant potential benefits for patients with advanced large B-cell lymphoma.  There are also some recognised risks and known side effects. Before deciding to have CAR-T immunotherapy, our team of experts will explain these to you in detail so you can make an informed decision about your treatment.  The two most common recognised risks are cytokine release syndrome and neurotoxicity: •    Cytokine release syndrome (CRS) When the modified T-cells are reintroduced to the body, they trigger production of a large amount of chemical messengers called cytokines. These cytokines stimulate the immune system. This can lead to flu-like symptoms including fever, muscle and joint pain, diarrhoea, nausea and vomiting, difficulty breathing, a fast heart rate, low blood pressure and dizziness. These symptoms usually develop during the first five to ten days after infusion. Treatment may be needed and around one in ten people may require treatment in intensive care.  •    Neurological side effects (neurotoxicity) CAR-T immunotherapy is associated with a risk of side effects impacting the nervous system. This is estimated to affect around two out of every three patients receiving this treatment and can lead to symptoms such as headaches, reduced consciousness, seizures or fits, confusion and difficulty speaking or balancing. These side effects usually start four to eight weeks after treatment. The severity varies and symptoms usually improve after one or two weeks.  Before, during and after treatment, our team of specialists will offer support and advice to help you manage any side effects. If you develop any of these side effects, treatment options will be available to aid your recovery.

T-cells are an important part of a healthy, functioning immune system, offering protection by seeking out and destroying bacteria and viruses.  T-cells also have the potential to destroy abnormal cells such as cancer cells.  Some cancerous cells are able to avoid detection by T-cells, enabling the cancerous cells to divide and grow. CAR-T immunotherapy aims to make modifications to the patient’s own T-cells, improving their ability to find, identify and destroy cancerous cells.

The process of CAR-T immunotherapy takes place over several weeks.  At London Haematology, treatment is provided in the Duchess of Devonshire Wing and you can attend each stage as a day patient.  Our specialist cell therapy team will provide all the advice and support you need throughout the course of your treatment and through the follow-up stage after treatment is completed. The stages of CAR-T immunotherapy are as follows: 1. Leukapheresis A sample of blood is taken over a period of three to six hours. T-cells are then removed from the sample. 2. CAR-T manufacturing The patient’s T-cells are transported to a laboratory where they are modified to enhance their ability to detect and destroy cancerous cells. In the lab, a process is then carried out to increase the number of modified cells. This process takes around three to four weeks. 3. Lympho-depleting Chemotherapy Chemotherapy is administered to the patient to maximise the ability of the CAR-T cells to create an effective response by reducing the number of unmodified T-cells in the blood. This usually takes place over three days and may be at a lower dose than you have received previously. If you prefer, you may not need to stay overnight at the hospital during this time. The chemotherapy may cause side effects including infection, hair loss and nausea. 4. YESCARTA infusion The CAR-T cells (the modified T-cells) are infused into the blood stream during a single hospital visit. This process takes around half an hour. Once in the body, the modified cells will remain active and circulating. 5. Daily monitoring period Close monitoring will be required for ten days following the YESCARTA infusion to identify any early signs of side effects. You may be able to stay at home during this period and only attend the hospital if treatment for side effects or additional monitoring is required. 6. Follow-up period Further follow-up will continue for a further three weeks to monitor for any late development of side effects or toxicities. We will be in regular contact with you by phone, providing all the support you need. You will also be able to contact our team at any time if you have any concerns. You may need to attend the hospital for blood tests and other monitoring. 7. Post-treatment reassessment Our team of specialists will review and assess the effectiveness of the treatment. You may need further screening tests at this stage including a PET or CT scan.