CAR T-Cell Therapy for Leukemia

Some patients whose leukemia hasn't responded to other therapies may benefit from an innovative immunotherapy treatment called CAR T-cell therapy. This treatment may also be used for some patients with relapsed or refractory leukemia.

What Is CAR T-Cell Therapy?

CAR T-cell therapy is a personalized immunotherapy, a cancer treatment that uses the body’s immune system to target cancer cells. In CAR T-cell cancer treatment for leukemia, your blood is collected during apheresis, a process that separates your T-cells—a type of white blood cell that fights infection—from the rest of your blood. The extracted T-cells are modified to target cancer. Next, they're modified in a lab and sent back to the hospital, where doctors put them back in your body through an IV infusion.

CAR T-cell therapy is a complex, advanced type of treatment that may cause serious side effects, so it is usually given during a hospital stay. Your treatment team will closely monitor your reaction to CAR T-cell therapy. Before you're sent home, they’ll explain how to care for yourself after you leave the hospital.

How Does CAR T-Cell Therapy Work?

In CAR T-cell therapy for leukemia, a patient's own cells are modified in the lab to attack cancer cells in the blood. Doctors take a blood sample and isolate the immune cells they need. Then, they manipulate those cells to give them a special chimeric antigen receptor (CAR), which lets them bind to cancer cells. The lab grows the modified CAR T-cells, which are reintroduced into the patient's blood stream so they can fight cancerous cells.

What Is Apheresis?

Apheresis is the process doctors use to collect the immune cells needed for CAR T-cell therapy. It involves taking blood from the body, isolating one or more blood components (such as plasma, platelets, or white blood cells), and then returning the remaining blood to the body.

What Is an Infusion Reaction?

An infusion reaction is an allergic response to the modified CAR T-cells when doctors introduce them to your bloodstream. Medical staff will monitor your vital signs and labs during your CAR T-cell infusion. They'll also give you Tylenol and Benadryl before the CAR T-cell infusion to help treat a reaction.

What to Expect When You Get CAR T-Cell Leukemia Treatment

You'll need an evaluation with a specialist to determine if CAR T-cell therapy is right for you before you can receive CAR T therapy for leukemia. Doctors will also re-stage your leukemia with a PET-CT scan unless you've recently had one, and you may require a bone marrow biopsy.

Next, a social worker will help you evaluate your mental, emotional, social, and spiritual needs and determine how we can support you and your family.

Finally, you will start the therapy itself:

• You will undergo apheresis, a process to collect your blood and isolate T cells.
• You will receive chemotherapy that is designed to prepare your body for the CAR T-cell infusion before the procedure begins.
• You'll meet with appropriate medical staff including: a nurse who will talk with you about your supportive care team members, an oncology social worker, a registered dietitian, spiritual care provider, and a member of the parenting at a challenging time (PACT) team at any period before, during, and after your infusion.

What to Expect After CAR T-cell Therapy

Your care team will tell you how to care for yourself when you leave the hospital. They will give you specific information about personal care, mouth care, and hand washing. They can answer any other questions that you may have.

You may need to make some lifestyle changes after CAR T-cell treatment, such as:

• You should have someone living with you in your house for at least one month after your infusion.
• You should avoid driving or operating heavy machinery for up to two months after your infusion.
• You must live within a two-hour drive of the hospital for a month after your infusion. For patients who live outside of this radius, housing options are provided.
• You will need to set up a healthcare proxy if you do not already have one. Your treatment team can provide you with a healthcare proxy form.
• You will receive a patient wallet card to carry with you at all times. If you see a doctor, you should give this card to them.

FAQs About CAR T-Cell Therapy for Leukemia

Who Is Eligible for CAR T-Cell Therapy for Leukemia?

CAR T-cell therapy for leukemia is intended for individuals whose condition either hasn't responded to traditional methods or has relapsed. As a result, a patient must typically have undergone prior treatment with standard chemotherapy to qualify for CAR T-cell therapy. Your care team will evaluate your eligibility based on the specific details of your case and recommend CAR T-cell for leukemia if it's a viable option.

What Is the Success Rate for CAR T-Cell Therapy for Leukemia?

CAR T-cell therapy has a verifiable track record of improving patient outcomes when other treatments have not been successful. According to a study, greater than 70% of patients achieve remission.

What Are the Possible Side Effects of CAR T-Cell Therapy?

No two patients are alike, and not all patients will have the same reaction to CAR T therapy. However, for some patients, the side effects of CAR T can be serious. You'll be closely monitored after your infusion. Report any of these side effects to your treatment team immediately.

Possible side effects include:

• Cytokine release syndrome (CRS), which can include fevers, low blood pressure, low oxygen levels, fast heartbeat, confusion, and temporary kidney and liver abnormalities
• Neurologic toxicities resulting in confusion, excessive sleepiness, tremor, or seizures
• Decreased blood counts
• Increased risk of infection
• Fever
• Chills
• Swelling in hands, arms, feet, and legs
• Increased risk of bleeding

If you experience any of these side effects after you leave the hospital, call your treatment team right away:

• Fever
• Confusion
• Excessive sleepiness
• Seizures
• Symptoms of infection
• Bleeding

It's common for someone else, like a family member, to notice changes in behavior (such as trouble remembering or confusion) before you do. Loved ones and caregivers should report any unexpected changes to your treatment team.

How Long Will I Need to Stay in the Hospital?

Hospital stays typically range from one week to two weeks but can last longer. The length of stay depends on your reaction to the CAR T-cell infusion and possible side effects.

Is CAR T-Cell Therapy FDA Approved for Leukemia?

Mass General Cancer Center is an authorized treatment center for FDA-approved CAR T-cell therapies for adult patients with multiple myeloma, lymphoma, and leukemia.

We use Kymriah and Tecartus for CAR T-cell therapy for leukemia. The FDA approved Kymriah and Tecartus in 2017 and 2020, respectively, to treat adult patients with relapsed or refractory. Talk to your doctor or oncology team to see if these drugs are appropriate for your case of leukemia.

Additional Treatment Options

Mass General Cancer Center offers patients access to a wide variety of clinical trials of promising new therapies. See if one of our open trials is right for you.

View Cellular Therapy clinical trials.

How Long Does CAR T-Cell Therapy Last for Leukemia?

CAR T therapy for leukemia takes about three months to complete. Studies on CAR T-cell therapy show significant remission rates even five years after the treatment.