CAR-T Cell Therapy

MUSC Hollings Cancer Center has offered adult and pediatric CAR-T cell (Chimeric Antigen Receptor T cell) therapy since 2019. Our board-certified hematologist-oncologists have expertise in matching patients to the right therapy, managing side effects and monitoring progress. Not only are our physicians committed to offering the latest therapies, but they are also part of the scientific community working to improve CAR-T cell therapy and make it more accessible. We offer a number of clinical trials, including a trial of purified CAR-T cells developed by scientists here at Hollings.

What is CAR-T cell therapy?

T-cells are a part of your immune system. Each T-cell is naturally primed to attack a specific foreign invader. CAR-T cell therapy is a way of boosting these T-cells so they do a better job of targeting cancer cells.

First, your T-cells are removed in a process called apheresis. This process is similar to donating blood, except that, instead of removing whole blood (red blood cells, white blood cells and plasma) for donation, your blood will move through a machine that separates out the white blood cells, which includes the T-cells. All of the other parts will be returned to your body.

The T-cells are then sent to a lab where a gene to produce a chimeric antigen receptor (CAR) is added to them. The CAR is primed to attack a protein found on cancer cells — the specific protein depends on the type of cancer. Those CAR-T cells are nurtured and multiplied in the lab, and then returned to your body, re-energized and ready to attack the cancer.

Cancers treated with CAR-T cell therapy

There are six CAR-T cell therapies approved to treat different blood cancers. At this time, CAR-T cell therapy is approved only when a cancer has returned (relapsed) or isn’t responding to traditional treatments (refractory).

Patients that could be eligible for CAR-T cell therapy include:

• Adults with relapsed or refractory B-cell non-Hodgkin lymphoma
• Adults with relapsed or refractory follicular lymphoma
• Adults with relapsed or refractory mantle cell lymphoma
• Adults, children or young adults with relapsed or refractory B-cell acute lymphoblastic leukemia
• Adults with relapsed or refractory multiple myeloma

Advantages and disadvantages of CAR-T cell therapy

CAR-T cell therapy is a newer type of therapy called immunotherapy that uses the power of your own immune system to attack cancer. Unlike chemotherapy, which attacks both healthy cells and cancer cells, CAR-T cells target only cancer cells. That does not mean it is without side effects; however, the side effects are usually temporary and the treatment can be powerfully effective.

One of the disadvantages of CAR-T cell therapy is its cost. It is an expensive treatment that might not be covered by insurance. We have a whole team, including nurses, a social worker and a financial coordinator, that can work with you to find out whether you have coverage. Hollings is currently conducting a clinical trial that involves manufacturing CAR-T cells right here at MUSC rather than sending them to an outside lab. If this is successful, it would bring down the cost to our patients a great deal.

Side effects of CAR-T cell therapy

CAR-T cell therapy can produce side effects that may require a brief hospitalization, which is why it is important that you stay in a home or hotel near the hospital for the first 30 days. Your care team will be on the lookout for these side effects and will provide you and your family with detailed information.

The most common side effect is cytokine release syndrome, an inflammatory response to the sudden infusion of new immune cells. Symptoms of this syndrome include fever, chills, low blood pressure, muscle aches and difficulty breathing.

A less common side effect is neurotoxicity, which can produce headaches, confusion, seizures and memory loss. This can be frightening for patients’ family members to see, but these symptoms are almost always fully reversible.

Preparing for CAR-T cell therapy

CAR-T cell therapy can be provided on both an outpatient and inpatient basis. Your doctor will look at several factors to determine which is best in your case, including your overall health, the type of CAR-T cell therapy you’ll receive and the amount of cancer cells in your body.

Even if you receive the infusion on an outpatient basis, there’s a good chance you’ll have to be hospitalized if side effects appear. However, most people appreciate the opportunity to spend fewer days in the hospital.

After your white blood cells are removed and sent to the lab, it usually takes several weeks to grow the CAR-T cells.

Before you get your CAR-T cell infusion, you will have lymphodepleting chemotherapy. This is chemotherapy to deplete (kill) your white blood cells (lymphocytes) to make way for the CAR-T cells.

You and your caregiver will receive detailed instructions about your care following the infusion.