CAR T-Cell Therapy

You will undergo a thorough evaluation with Duke blood cancer specialists. You may be a candidate for CAR T-cell therapy if you have tried other treatments without success. Your eligibility depends in part on your disease type and the available treatment options. Your evaluation will also include a meeting with a financial counselor to determine if your health insurance covers this new therapy.

We offer the following FDA-approved CAR-T cell therapy treatments: 

• Abecma^® for relapsed or refractory multiple myeloma
• Aucatzyl^® for relapsed or refractory B-cell acute lymphoblastic leukemia
• Breyanzi^® for relapsed or refractory large B-cell lymphoma
• Carvykti^TM for relapsed or refractory multiple myeloma
• Kymriah^® for relapsed or refractory acute lymphoblastic leukemia and relapsed or refractory non-Hodgkin lymphoma
• Tecartus^TM for mantle cell lymphoma and relapsed or refractory acute lymphoblastic leukemia
• Yescarta^® for refractory non-Hodgkin B-cell lymphoma

Some children and young adults with acute lymphoblastic leukemia may be eligible for CAR T-cell therapy. Our pediatric stem cell transplant and cellular therapy experts conduct comprehensive evaluations to determine if CAR T-cell therapy with Kymriah® may be a safe and effective treatment for your child. 

If you or your child isn't eligible for CAR T-cell therapy, we can determine if a Duke clinical trial offers another appropriate treatment option. For example, you may be eligible to participate in clinical trial evaluating the effectiveness of cell therapy for sarcoma, prostate cancer, melanoma, or other cancer types. In addition, our pediatric immune effector cell program may offer some children and young adults the opportunity to enroll in clinical trials on CAR-T cell products. 

The first step of the therapy is a four-hour outpatient process called apheresis. During this procedure, blood is drawn from your body, 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). This allows each cell to recognize and more effectively attack cancer cells.

It takes several weeks 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 disease from progressing during that time.

Treatment schedules can differ for everyone, and your bridging therapy will be personalized to your needs. In addition, you will complete a three-day lymphodepleting chemotherapy on the days immediately before your CAR-T infusion.

When it’s time to infuse your CAR T-cells into your blood, you’ll either receive the infusion and monitoring in the outpatient clinic or in the hospital, depending on your needs. The infusion of cells takes about 10 minutes. After your infusion, your doctors will watch for side effects and minimize any 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.

As part of the process, you could experience impaired motor function, even when the infusion is working properly. Doctors may test your ability to write or speak to make sure you’re recovering properly. The length of your hospital stay will depend on the severity of any side effects and how long they take to resolve. The average stay is about two weeks.

Whether you receive your infusion in the outpatient clinic or in the hospital, you’ll visit the Duke Blood Cancer Center daily for up to 30 days from the day of your infusion so your progress can be monitored. During this time, you may experience fatigue, high fevers, and seizures. You must have a caregiver and should not drive for at least eight weeks after CAR-T cell infusion.

About 30 days after your infusion, you’ll undergo a positron emission tomography (PET) scan. Your oncologist will review the results with you to evaluate the effectiveness of the CAR T-cell therapy.

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.