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CAR T-cell Therapy
This is a living drug that uses your own infection-fighting white blood cells (called T-cells) to seek out and destroy cancer cells.
How it Works
First, we remove some of your T-cells from your blood. We will send these T-cells to a lab where the cells are altered to produce proteins called chimeric antigen receptors (CARs) on the surface of the cells. These receptors allow the T-cells to help find and attack cancer cells. These “super-charged”
T-cells are multiplied and grown at the lab, then frozen and shipped back to UW Health. We will then infuse the CAR-T cells back into your body.
Treatment Requirements
To receive CAR-T at UW Health you must meet both of the requirements below:
You have large B-cell lymphoma, mantle cell lymphoma, multiple myeloma or acute lymphocytic leukemia.
You did not respond to, or who have relapsed after, at least 2 other treatments.
Your oncologist will refer you to the UW Health Bone Marrow Transplant (BMT) program. The BMT program will decide if you meet the requirements for CAR-T therapy.
Treatment Process
Phone Call
The Bone Marrow Transplant coordinator will call you to:
Talk about your health history
Figure out if you may be a candidate for CAR-T cell therapy
Ask for your insurance information and our financial team will confirm that your insurance plan covers CAR-T cell therapy
Set-up a consult visit to confirm you are a candidate for CAR-T cell therapy
Consult Visit
At this visit, we will confirm if CAR-T cell therapy is right for you. We will also review:
Treatment process
Tests you need to complete, which may include labs, echocardiogram, bone marrow aspiration, lumbar puncture, echocardiogram, pulmonary function tests, CT scan, and others.
Insurance approval
The CAR-T cell products
Planning Your CAR-T cell Therapy
Your Bone Marrow Transplant team will create a plan for your CAR-T cell therapy. This plan includes:
Choosing the CAR-T cell product that will be used
Working with your oncologist to decide if you also need chemotherapy
Planning when your T-cells will be collected (leukapheresis)
Once we receive approval from your insurance and your tests confirm you are a candidate for this treatment, we will start the leukapheresis process.
Leukapheresis
Your treatment uses the T-cells in your bloodstream. Your T-cells will be removed from your body through a process called apheresis. This process takes 3-4 hours.
For apheresis, you will go to the Infusion Center (C5/350) at University Hospital. We will be checking your blood pressure and pulse throughout the collection and watch for any side effects.
Apheresis Process
We will insert two intravenous (IV) lines into your vein. We may need to place a central line instead if your veins are hard to find.
We will connect these lines to a machine that performs apheresis.
The apheresis machine will take small amounts of blood out of your body. The machine then spins the blood and pulls out the T-cells.
The machine will then return the rest of your blood back to you.
Side Effects of Leukapheresis
Some patients will have side effects during apheresis. Your nurse can help you manage these. You may feel:
Dizzy
Lightheaded
Nauseous
Tingling in the lips, toes and fingers (which can be caused by the anti-clotting medicine)
Wait Time (3-4 Weeks)
It may take about 3-4 weeks for the lab to prepare your T-cells for treatment. Your oncologist will still be in charge of your care during this time. The Bone Marrow Transplant team will stay in contact with your oncologist to stay informed about your health. Some patients will need chemotherapy during this wait time.
Conditioning Therapy and Infusion
Our team will contact you when your CAR-T treatment is ready.
Chemotherapy
Before the infusion of your CAR-T cells, you will receive chemotherapy. Most often, we will use Fludarabine and Cyclophosphamide. You will receive the chemotherapy as an outpatient or inpatient.
CAR-T Cell Infusion
You will then have the CAR-T cell infusion 2-14 days after you finish the chemotherapy. The infusion takes about 30 minutes. You will have the infusion as an outpatient or inpatient depending on the CAR-T cell product you receive. Your Bone Marrow Transplant Coordinator will tell you where you infusions will happen.
After Your Infusion
Follow-up Visits
You will have daily follow-up visits in the clinic for about 2 weeks. After that, you will have at least 1 visit a week for 3-6 more weeks. Each visit will take 2-8 hours depending on lab, infusion and transfusion needs. You may need to stay in the hospital on and off for the 8 weeks after the infusion.
Cytokine Release Syndrome (CRS)
CRS is a potentially serious side effect of CAR-T therapy. Cytokines are produced when the CAR-T cells multiply. You may have flu-like symptoms, such as:
Fever (100.4°F or greater)
Chills
Headache
Extreme fatigue
Nausea
Shortness of breath
Immune Effector Cell Associated Neurotoxicity Syndrome (ICANS)
ICANS is another potentially serious side effect of CAR-T therapy. It can usually be reversed. Common symptoms include:
Trouble speaking
Confusion
Irritability
Lethargy
Delirium
Involuntary muscle twitching
Hallucinations
Seizures
Unresponsiveness
CRS and ICANS symptoms most often occur within 14 days after infusion of the
T-cells but can occur up to 8 weeks after your infusion.
Safety Guidelines
Due to the risk for CRS and ICANS you must follow certain safety guidelines.
Do not drive, operate heavy machinery or do other dangerous things for 8 weeks.
Stay in Madison, or within a 2 hours’ drive of University Hospital for at least 4 weeks (up to 8 weeks).
Have a caregiver with you 24 hours a day to watch for signs and symptoms of CRS and CRES.
Work
You will likely need to take off work for 6 months after your infusion.
When to Call
Call the BMT team right away if you have any of symptoms of CRS or ICANS or if you have other questions or concerns.
Who to Call
Carbone Cancer Center
608-265-1700
Ask to speak to the BMT attending on call.
