CAR T-cell Therapy for Lymphoma: What's Involved, Potential Outcomes

Summary: CAR T therapy (chimeric antigen receptor therapy) is a new treatment strategy that has been shown to improve patient outcomes. In this lecture, Dr. William reviews the steps involved, including T-cell collection, lymphodepleting chemotherapy, reinfusion of T-cells, and follow-up care. Potential side effects and their treatments are discussed as well.
Presenter: Basem William MD, MRCP, FACP, OhioHealth
Many thanks to Kite, a Gilead Company whose support helped make this Survivorship Symposium possible.
To read the transcript, go to:
bmtinfonet.org/video/car-t-ce...
Highlights:
(02:58): The reason why CAR T-cell therapy works, when chemotherapy fails, is because CAR T-cell therapy kills cancer cells using a different mechanism than chemotherapy.
(03:55): The FDA has approved CAR-T therapy for patients with relapsed or refractory diffuse large B-cell lymphoma, follicular lymphoma, mantle cell lymphoma, B-cell acute lymphoblastic leukemia, chronic lymphocytic leukemia, and multiple myeloma.
(05:54): 60% of lymphoma patients treated with standard chemotherapy can be cured. The remaining 40% will need additional treatment to prolong their life and/or be cured.
(08:09): Once a patient is referred to a CAR T center, it can take 10-21 days to get insurance approval for the procedure and reserve a slot at the facility that will manufacture the T-cells.
(09:00): Once the patient’s T-cells are collected, it can take 10-28 days for the manufacturing company to covert them into CAR T-cells.
(11:04): Once the T-cells are back at the center, patients receive lymphodepleting chemotherapy three days before the T-cells are reinfused back into the patient.
(13:11): Patients are seen by a provider daily for four weeks after CAR T-cell therapy. Remote monitoring technology is being used by some centers to help detect problems in a timely manner.
(14:16): Cytokine release syndrome (CRS) causes inflammation after CAR-T therapy. Symptoms include fever, low blood pressure and shortness of breath.
(16:21): Neurotoxicity, also known as ICANS (Immune Effector Cell-Associated Neurotoxicity), occurs when cytokines cross the blood-brain barrier. Symptoms include tremors, confusion, and seizures.
(19:35): While many patients do not experience long-term side effects of CAR-T therapy, some patients experience long-term loss of B-cells that requires ongoing intravenous immunoglobulin infusions and antiviral medication, and low blood counts.
May 2024, Part of the Virtual Celebrating a Second Chance at Life Survivorship Symposium
The presentation is 40 minutes long with 19 minutes of Q&A.
Key Points:
CAR-T therapy involves collecting a patient's own T-cells, genetically modifying them to attach to the cancer cells and kill them, and then reinfusing them back into patients after lymphodepleting chemotherapy.
Patients receiving CAR T therapy are at risk for cytokine release syndrome (CRS) and neurotoxicity (ICANS). These can be potentially severe side effects, so patients need to be near the cancer center for four weeks after receiving their infusion of CAR T-cells.
CAR T-cell therapy has been successful in improving survival and cure rates for patients with various types of lymphoma.
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