What Is CAR T-Cell Therapy?
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CAR T-cell therapy trains a type of your body’s white blood cells, called T-cells, to recognize and fight cancer. The cells are removed from your blood, altered in a lab, then returned to your body through an infusion.
Candidates for CAR T-Cell Therapy
Candidates for CAR T-cell therapy have failed two separate systemic treatments -- which could include chemotherapy or bone marrow or stem cell transplants -- and by a relapsed after each.
Types of non-Hodgkin lymphomas eligible for treatment with Yescarta and/or Kymriah include:
- Diffuse large B-cell lymphoma (DLBCL)
- Primary mediastinal large B-cell lymphoma (PMBCL)
- High grade B-cell lymphoma
- DLBCL arising from follicular lymphoma (FL)
Additionally, Kymriah can also be used to treat patients up to the age of 25 who have some kinds of B-cell acute lymphoblastic leukemia (ALL).
Comprehensive Evaluation
As part of your evaluation to receive CAR T-cell therapy, you’ll consult with Duke specialists to see if it’s right for you. This evaluation includes a meeting with a financial counselor to determine how health insurance may cover this new therapy.
If you aren’t eligible for CAR T-cell therapy, there may be other options for treatment, and we can work with you to see if there are clinical trials offered at Duke to treat your disease in another way.
The CAR T-Cell Therapy Process
Apheresis
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The first step of the therapy is a four-hour outpatient process called apheresis. During this procedure, blood is drawn from your body via a tube, filtered to collect T-cells, and returned to your body.
Your cells will be sent to an off-site scientific lab, where they will be enhanced with a chimeric antigen receptor (CAR). It works like an antenna, allowing each cell to recognize and more effectively attack cancer cells.
Chemotherapy or Radiation Therapy
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It takes 17-to-24 days to grow the millions of new CAR T-cells you’ll need, so your doctor may recommend a bridging therapy such as chemotherapy or radiation therapy to prevent your health from deteriorating during that time.
Treatment schedules can differ for everyone; your bridging therapy will be personalized to your needs. Along with that individual treatment plan, every CAR-T recipient will complete a three-day lymphodepleting chemotherapy that takes place on the days immediately before the CAR-T infusion.
CAR T-Cell Infusion
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When it’s time to infuse your CAR T-cells into your blood, you’ll be admitted to Duke University Hospital as an inpatient. The infusion will take place the following day and will take about 10 minutes. You’ll remain in the hospital and be monitored for side effects until your doctors decide it’s appropriate to care for you on an outpatient basis.
Monitoring for Side Effects, T-Cell Effectiveness
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After your infusion, your doctors will watch for side effects and minimize reactions, which could include fatigue, fever, and seizure-like events. These side effects are expected and can last for days as your body reacts to the new T-cells aggressively attacking your cancer.
Part of the process could cause an impairment of motor function, even when the infusion is working properly. Doctors may use tests to monitor your ability to write or speak as a way to make sure you’re OK during recovery. Inpatient stays vary, depending on severity of side effects and when reactions have been minimized for discharge. The average stay is about two weeks.
After You Leave the Hospital
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Once you’re discharged from the hospital, you’ll visit the Duke Adult Blood and Marrow Transplant Clinic daily for up to 30 days from the day of your infusion so your progress can be evaluated. You will remain at risk for fatigue, high fever, and seizure.
PET Scans
About 30 days after your infusion, you’ll undergo a positron emission tomography (PET) scan, an imaging procedure your oncologist will review with you to evaluate the effectiveness of the CAR T-cell therapy.
If You Have an Emergency
Duke has an FDA-approved Risk Evaluation and Mitigation Strategy Program to address any risks and side effects associated with CAR-T therapy. If you have a medical emergency during your recovery, you’ll use a special ID card to show emergency room staff and providers that you are a CAR-T patient. This will help our team to provide you with specialized treatment.
Staying Nearby During Your Care
Because CAR-T recipients must stay locally for an extended period of time, Duke can work with you to find housing if you’re traveling from outside the Triangle. Duke Patient Information Services will work with you and your loved ones to find nearby affordable lodging. Staff can also check to see if you’re eligible for financial assistance for housing.
