CAR T-Cell Therapy

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Chimeric Antigen Receptor (CAR) T-Cell therapy is a personalized immunotherapy that uses your own cells to fight advanced lymphomas. It may be recommended when at least two other treatments have not been effective. Duke is one of three North Carolina centers certified to administer two FDA-approved CAR T-cell therapies for non-Hodgkin lymphoma: Yescarta and Kymriah. Kymriah is also approved for treatment of leukemia in pediatric patients and young adults.

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What Is CAR T-Cell Therapy?

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.

Our Locations

Duke Health offers CAR T-Cell therapy at the Duke Adult Blood and Marrow Transplant Clinic.

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The CAR T-Cell Therapy Process

Apheresis

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

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

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

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

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.

Why Choose Duke

A National Standard of Excellence
Duke is accredited to provide CAR T-cell therapy by the Foundation for Accreditation for Cellular Therapy, a nonprofit organization committed to quality care. This means you and your family can feel confident that your providers are among the country’s leaders in using this new therapy.

Advancing Cancer Treatments
Our researchers explore genetic differences among lymphomas that will lead to improved therapies. Novel techniques such as less intense stem cell transplants, pioneered in part at Duke, offer hope to people with lymphoma.

Family-Based Support
During your care, our cancer support services offer a variety of ways to care for you and your loved ones, including support groups, counseling, and more. You can find a listing of options on our event calendar.

Best Cancer Hospital in North Carolina

Where you receive your cancer care is important. Duke University Hospital is proud of our team and the exceptional care they provide. They are why our cancer program is nationally ranked, and the highest ranked program in North Carolina, according to U.S. News & World Report for 2020–2021.

Reviewed: 11/26/2019