CAR T-Cell Therapy, Step by Step: What to Expect

CAR T-cell therapy is a treatment made from your own immune cells. It can feel like a lot to take in, so here's what happens at each step, in plain words.

What is CAR T?

CAR T-cell therapy changes the genes in a person's T cells to help them attack cancer.² The T cells are engineered to make special proteins on their surface called chimeric antigen receptors, or CARs.¹ Because it uses your own T cells, one expert quoted by the National Cancer Institute calls it a "living drug." After the infusion, the cells are meant to keep expanding in your body and kill cancer cells.¹

The FDA has approved CAR T-cell therapies for some kinds of lymphomas and leukemias, as well as multiple myeloma. It's usually used after other treatments have been tried.²

Step 1: Collecting your T cells

This step is called apheresis. Your blood flows out and through a machine that keeps the white blood cells and returns the rest of your blood to your body.³ It usually takes about 3 to 6 hours.³

• You may feel dizzy or cold, or notice numbness or tingling.³
• Numbness or tingling in your fingertips or around your mouth is a sign of low calcium, so tell your nurse.⁴
• If more cells are needed, collection can be repeated.³

Steps 2 and 3: Building and growing your cells

In a lab, your T cells are changed to carry CARs.² Then they're grown until there are hundreds of millions of them.¹ From blood collection to infusion, this takes about 3 to 5 weeks.¹

Step 4: Conditioning chemo

A few days before your infusion, you'll likely get a short, fairly mild course of chemo. It lowers the number of other immune cells in your body.² For YESCARTA, one CAR T product, this is 3 days of chemo given on the fifth, fourth and third days before infusion.⁵

Step 5: Infusion day

Your CAR T cells go back into your body through an IV.² For YESCARTA, you get acetaminophen and an antihistamine about an hour before, and the whole bag is given within 30 minutes.⁵

Step 6: Monitoring and recovery

• With YESCARTA, your team checks you at least daily for the first 7 days after infusion.⁵
• Plan to stay near a healthcare facility for at least 2 weeks after infusion.^5,6
• Avoid driving for at least 2 weeks.⁵ Your team may give you different instructions, so follow theirs.
• New cancers, including T-cell cancers, have happened after treatment, so you'll be watched for them for life.⁵

Side effects to know

Cytokine release syndrome (CRS). The new T cells can release large amounts of cytokines, which can cause dangerously high fevers and sudden drops in blood pressure.¹ Signs include high fever and chills, trouble breathing, dizziness, a fast heartbeat and tiredness.²

Neurologic effects (ICANS). Signs can include confusion, headaches, seizures, tremors, and trouble speaking or understanding.²

Infections and low blood counts. CAR T can weaken your immune system, raising the risk of serious infections, and it can lower your blood cell counts.²

Know your fever number. Memorial Sloan Kettering, for example, tells patients to call their healthcare provider for a fever of 100.4°F (38°C) or higher after their T cell collection.⁴ Ask your own team exactly when to call, day or night.

Sources

1. CAR T Cells: Engineering Patients' Immune Cells to Treat Their Cancers, National Cancer Institute
2. CAR T-cell Therapy and Its Side Effects, American Cancer Society
3. Collecting Cells for CAR T-cell Therapy, St. Jude Children's Research Hospital, Together
4. About Your T Cell Collection, Memorial Sloan Kettering Cancer Center
5. YESCARTA (axicabtagene ciloleucel) Prescribing Information, U.S. Food and Drug Administration
6. FDA Eliminates Risk Evaluation and Mitigation Strategies (REMS) for Autologous CAR T Cell Immunotherapies, U.S. Food and Drug Administration

For education only, not medical advice. Every treatment center and CAR T product is a little different, so always follow your care team's instructions.