CAR T-Cell therapy can be a very good treatment for patients with aggressive Non-Hodgkin lymphoma & certain types of leukemia in children and young adults have recently been approved by FDA (Food and drug administration). This cell therapy is useful for treatment in certain children and young adults suffering from Non – Hodgkin lymphoma. Treatment with Yeskarta & Kymriah is the first CAR T-Cell therapy to receive FDA approval.
Novartis manufactures tisagenlecleucel, which is used for patients up to the age of 25 suffering from B-Cell ALL that is not responding to other forms of treatment or has relapsed two or more times.
What is CAR T-Cell therapy (Chimeric antigen receptors) ?
CAR T-Cell therapy is a form of immunotherapy that uses specially modified T-cells which are part of our immune system to fight cancer. A sample of patients T cells are collected from the blood, then it is modified to to produce special structures called chimeric antigen receptors (CAR) on their surface. When these modified CAR cells are re infused in the patient, these new cells attacks the specific antigen and kills the tumour cells.
How CAR T-Cell therapy works ?
CAR T-cell therapy takes help from body’s own immune system to attack and kill cancer cells. This is done by removing some specified cells from the blood of the patient, modifying them in the lab and re injecting them into the patient. CAR T-cell therapy has produced very encouraging results in Non-Hodgkin lymphoma and thus approved by FDA.
Who are the right candidates for CAR T-Cell therapy ?
At present FDA has approved CAR T-Cell therapy for some forms of aggressive and refractory Non-Hodgkin lymphoma and relapsed and refractory acute lymphoblastic leukemia. Patient need to send full medical reports to ascertain the use of CAR T-Cell therapy for his treatment.
Inclusion criteria for CAR T-cell therapy :
1. Patients with CD19+ B-cell Lymphoma(At least 2 prior combination chemotherapy regimens)
2. To be aged 3 to 75 years
3. ECOG score ≤2
4. Women of childbearing potential must have a urine pregnancy test taken and proven negative prior to the treatment. All patients agree to use reliable methods of contraception during the trial period and until follow-up for the last time.
Exclusion criteria for CAR T-cell therapy :
1. Intracranial hypertension or unconsciousness
2. Respiratory failure
3. Disseminated intravascular coagulation
4. Hematosepsis or Uncontrolled active infection
5. Uncontrolled diabetes
What are the possible side effects of CAR T-cell therapy ?
Most of the patients on chemotherapy experience some sort of side effects like hair loss, nausea, and vomiting, however, these side effects are not commonly seen with CAR T-Cell therapy. Having said that patients may suffer from many other side effects and thus patients are usually kept admitted under observation for several weeks.
Possible side effects from CAR T-cell therapy include:
- Cytokine release syndrome: CAR T cells can initiate a massive release of substances called cytokines, which triggers an inflammatory condition known as cytokine-release syndrome (CRS). Symptoms may be flu-like, with a high fever and/or chills; low blood pressure; difficulty breathing; or confusion. These symptoms can be mild or severe.
- Neurologic difficulties: Patients may also experience confusion, difficulty understanding language and speaking, or stupor.
Treatment process for CAR T-Cell therapy ?
- Complete evaluation of the patient
- T-cell collection from the body
- T-cells are then engineered in the lab
- Genetically engineered T-Cells are then multiplied by using growing them in the laboratory. These cells are frozen and then sent to the treating centres.
- Prior to infusing, patient may be given chemotherapy for their cancer. This helps the therapy work in a better way.
- Soon after chemotherapy CAR T-Cells are infused by a process which is similar to blood infusion.
- There is a 2-3 month of recovery period for the patient.
Time frame for CAR T-Cell therapy
1. Examination & test: one week
2. Pre-treatment & T-Cell Collection: one week
3. T-Cell preparation & return: two-three weeks
4. 1st Effectiveness analysis: three weeks
5. 2nd Effectiveness analysis: three weeks
Cost of CART T-Cell therapy
Total cost of CAR T-cell therapy can be anything between $ 400,000 to 7,00,000 USD in USA. However, there are centers in Asia which are doing the same treatment in $85000 – 95000 USD.