Cellular Therapy -

Cellular Therapy

Cellular Therapy is the administration of cells

Cellular therapy is one of the most groundbreaking advances in modern medicine. The FDA has approved several cellular therapy products to be used in cancer medicine with the use of CAR T-cells. The patient’s T-cells are genetically engineered to kill the cancer cells using cellular immunotherapy and ultimately save the lives of patients with certain forms of cancer.

30 years experience in hematopoietic stem
cell transplantation and cellular therapy

CAR T-Cell Therapy

The newest and most promising blood cancer treatment is chimeric antigen receptor CAR T-cell therapy. This therapy uses the body’s immune system to aid in fighting cancer. Certain immune cells are designed to detect and eliminate abnormal cells, such as cancer, before they can cause disease—but sometimes, they fail to do so. CAR T-cells therapy solves this problem by using the patient’s own immune cells which are collected, genetically modified to better recognize cancer, and then reintroduced into the body to target and destroy cancer cells.

In 2017, the FDA approved certain types of CAR T-cell therapies which ultimately provided treatment to leukemia, multiple myeloma, and some lymphoma cancers. This treatment has proven to save the lives of patients with no other treatment options.

Who Can Benefit from CAR T-Cell Therapy?

Patients that have a leukemia called B-cell ALL can benefit from this treatment if

1. Pediatric and Young Adult Patients with B-cell Acute Lymphoblastic Leukemia (B-ALL)

CAR T-cell therapy may be beneficial if the patient meets any of the following criteria:

They are 25 years of age or younger.
Their cancer has not responded after two cycles of chemotherapy.
Their disease has relapsed after a stem cell or bone marrow transplant.
Their disease has relapsed two or more times.
They are not eligible for a stem cell transplant due to medical or other reasons.

2. Adult Patients with B-cell Lymphomas

CAR T-cell therapy may be appropriate in the following situations:

The patient has diffuse large B-cell lymphoma (DLBCL) that has relapsed or progressed after at least two prior lines of systemic chemotherapy, or is refractory to standard therapies. CAR T-cell therapy may help achieve disease control where conventional salvage regimens have failed.
The patient has primary mediastinal B-cell lymphoma (PMBCL) that is relapsed or refractory. In adolescents and young adults, CAR T-cell therapy has shown clinical benefit after failure of at least two prior therapies.
The patient has mantle cell lymphoma (MCL) that has relapsed or become refractory following treatment with a Bruton’s tyrosine kinase (BTK) inhibitor, such as ibrutinib or acalabrutinib. CAR T-cell therapy is an approved option for adults and older adolescents in this setting, with ongoing studies evaluating its role in younger populations.

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The CAR T-Cell Therapy Process

1

Collection

T-cells are collected from patients with certain types of cancer through a process called apheresis. Blood is drawn from one arm and passed through a special machine that separates its components. For CAR T-cell therapy, the machine isolates and collects T-cells, while the remaining blood components are returned to the patient through a tube in the other arm. This collection process typically takes 4 to 5 hours.

2

Transduction

The collected T-cells are sent to specialized laboratories, where they undergo a process called transduction. During this step, a harmless virus is used to insert new genetic material into the T-cells. This genetic information reprograms the T-cells to become CAR T-cells—engineered immune cells specifically designed to recognize and destroy cancer cells.

3

Expansion

Over the course of about two weeks, the engineered CAR T-cells multiply into hundreds of millions in the lab. During this time, doctors prepare the patient’s body to receive the therapy through a process called lymphodepletion. This involves administering chemotherapy to reduce the patient’s existing immune cells, which helps prevent rejection and allows the CAR T-cells to function more effectively once infused.

4

Infusion and Monitoring

Once the CAR T-cells have multiplied and the patient has completed lymphodepletion, the cells are shipped from the lab to the hospital. They are then given to the patient through an IV, similar to a blood transfusion. After the infusion, doctors and nurses closely monitor the patient—usually for at least two weeks. Patients typically stay in the hospital or nearby, and are often advised to remain within 30 minutes of the treatment center for up to 28 days to ensure quick access to care if needed.

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

CAR T-Cell Therapy Side Effects

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:

Confusion
Tremors (shaking) or seizures
Trouble speaking
Loss of balance or consciousness
Other serious side effects that may require medical attention include:
Abnormal levels of important minerals in the blood
Allergic reactions

Testimonials

Physician Hospitalist
Nurse Practitioner
Daniel Couriel, MD, MS, MBA
CAR T- Cell Patient