CAR-T Cell Therapy : What It Is & How It Works

What is CAR-T Cell Therapy?

CAR-T cell therapy is an innovative treatment that reprograms the immune system to fight cancer. In this type of immunotherapy, T-lymphocytes (also known as T-cells, white blood cells critical to the immune system) are genetically engineered to have a special receptor called the Chimeric Antigen Receptor (CAR), which enables them to detect and destroy cancerous cells more effectively.

Why is CAR-T cell therapy done?

CAR-T Cell Therapy is a modern form of Immunotherapy which is effective against various types of cancers, even when other treatments are not working. Cancers that can be treated include lymphomas, leukemias, and certain recurrent blood cancers. CAR-T cell therapy is approved by United States Food and Drug Administration (USFDA) for treating hematological malignancies. CAR T cells identify and attack cancer cells in a patient body to stop the cancer from growing both immediately and in the long term.

What happens during CAR-T cell therapy?

CAR-T cell therapy involves following steps:

• Collection: T cells are collected from a patient via leukapheresis. In leukapheresis, blood is withdrawn from patient’s body. The white blood cells including T-cells are separated from blood and the remaining blood is returned to the body.
• Re-engineering: The collected T cells are genetically modified in a laboratory by introducing a gene to produce chimeric antigen receptors (CARs) on the surface of the cells. The re-engineered T-cells are cultured and multiplied to increase their numbers.
• Re-infusion: Once a sufficient number of reengineered CAR-T cells are obtained, they are infused back into the patient’s bloodstream, after patient undergoes a brief course of chemotherapy to reduce the number of normal T-cells in the body (known as Lymphodepletion).
• Targeting and destruction: The CAR-T cells that have been returned to the patient’s bloodstream multiply in number. These CAR-T cells are now equipped to recognise and target the specific cancer cells they were reengineered to attack.
• Protection against recurrence: CAR T-cells not only eradicate cancer cells in the body, but offers the potential for long-term immunity against the cancer and reduces the chances of cancer recurrence.

How long will it take?

The entire CAR-T cell therapy process will take approximately 45 days, i.e. from the collection of T-cells to post-infusion follow-up treatment. Based on your health condition, your doctor will decide whether the therapy should take place in an outpatient setting or an inpatient setting of the hospital.

What happens after the procedure?

CAR-T cell therapy is a complex and personalised treatment option. In selected cases, this treatment has shown promising outcomes, however, it may have side effects, such as cytokine release syndrome (CRS) and CNS toxicity. Your doctor will monitor you following CAR-T cell therapy to assess treatment progress or for any side effects. If your doctor is satisfied with your recovery, discharge will be planned and follow-up appointment will be scheduled to see the course of the treatment.

Apollo expertise in the procedure

In a ground-breaking development, Apollo Cancer Centres (ACCs) has emerged as the first private hospital group in India to have a successfully launch the CAR-T cell program. To further augment the program, the group now provides access to ‘Made in India’ CAR-T cell therapy, beginning with NexCAR19™ (Actalycabtagene autoleucel), for the treatment of B-cell lymphomas and B-acute lymphoblastic leukaemia in patients aged 15 years and above.

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FAQs

Who is eligible for this treatment?
The FDA has approved six CAR-T-cell therapies for treating blood cancers like lymphomas,
certain types of leukemia, and multiple myeloma.

• Relapsed B cell – Acute Lymphoblastic Leukemia (B-ALL): One potential approach is to use CAR-T cell therapy after the initial treatment to strengthen its impact.
• Relapsed B cell- Non-Hodgkins Lymphoma (higher grade): It’s typically given after multiple rounds of treatment. CAR-T cell therapy showed impressive response rates and the chance for long-lasting remission, even after previous treatments have failed.

Patients eligible for CAR-T cell therapy must meet FDA criteria and be in good overall health to handle the waiting period and potential side effects. Patient’s T-cells should be healthy for successful treatment.

What is the benefit of CAR T-cell therapy?

• Patients can usually recover well with proper care and observation over 2–3 weeks
• Offers better outcomes compared to traditional cancer treatments, potentially leading to longer-term remission and improved quality of life.
• Demonstrates remission in patients who had previously undergone multiple unsuccessful cancer treatments.
• Quick intervention time and single infusion of CAR-T cells.
• Shorter treatment time.
• Beneficial in identifying and destroying cancer cells during disease relapse