CAR T-Cell Therapy for Multiple Myeloma

CAR T-cell therapy is an innovative treatment for some patients with non-Hodgkin lymphoma, multiple myeloma, and B cell acute lymphoblastic leukemia (B-ALL) that has not responded to other therapies. Each therapy has a targeted purpose that’s designed for a specific lymphoma, multiple myeloma, or leukemia. CAR T-cell therapy for multiple myeloma also offers treatment for some patients with relapsed or refractory multiple myeloma.

What Is CAR T-Cell Therapy?

CAR T-cell therapy is a personalized immunotherapy, the category of cancer treatment that uses the body’s immune system to find and attack cancer cells. In CAR T-cell cancer treatment for multiple myeloma, your blood is collected through a process called apheresis that separates your T-cells—a type of white blood cell that fights infection—from the rest of your blood. Your T-cells are then engineered to attack multiple myeloma cells. The engineered T-cells are multiplied and sent back to the hospital, where they are reintroduced to your body through an IV infusion. 

CAR T-cell therapy is a complex treatment that can cause serious side effects, so it is usually given during a stay in the hospital. Depending on your situation, you may also receive it on an outpatient basis. Regardless, your treatment team will carefully monitor you for any side effects of CAR T-cell therapy. They’ll discuss potential side effects and how to best care for yourself after you leave the hospital.

How Does CAR T-Cell Therapy Work?

In CAR T-cell therapy for multiple myeloma, a patient's own cells are modified in the lab to attack cancer cells in the blood. Once blood is removed from a patient, T-cells gain a special chimeric antigen receptor (CAR), which can bind to a protein on the cancer cells. The CAR T-cells are multiplied in the lab and then reintroduced to the patient via blood infusion to attack cancerous cells.

What Is Apheresis?

Apheresis is the process used to collect T-cells from your blood. It involves taking blood from the body and removing one or more blood components such as plasma, platelets, or white blood cells. The remaining blood is then returned to the body.

What Is an Infusion Reaction?

An allergic response is possible when the CAR T-cells are infused into your blood. Your treatment team will closely monitor your vital signs and labs during your CAR T-cell infusion. You will also be given Tylenol and Benadryl before the CAR T-cell infusion to help treat a reaction.

What to Expect When You Get CAR T-Cell Multiple Myeloma Treatment

Before you get CAR T-cell therapy for multiple myeloma, you will have a medical and laboratory evaluation with a specialist to determine if CAR T-cell therapy is right for you. Your multiple myeloma will be re-staged with a PET-CT scan unless you've recently had one, and you may require a bone marrow biopsy as well as blood and urine tests.

Next, you will meet with a social worker to evaluate your mental, emotional, social, and spiritual needs and determine the support we can provide you and your family.

Finally, you will start the therapy itself:

• You will undergo apheresis, a process where your blood is collected and processed to obtain the T-cells.
• Before being admitted to the hospital, you will receive chemotherapy that is designed to prepare your body for the CAR T-cell infusion.
• Your nurse will talk with you about your supportive care team members. You will meet with an oncology social worker. You will also have access to a registered dietitian, spiritual care provider, or a member of the parenting at a challenging time (PACT) team at any period before, during, and after your infusion.

What to Expect After the Infusion

Your treatment team will talk with you about 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.

Additionally, you may need to modify your lifestyle after CAR T-cell treatment. Specifically:

• 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 2 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. If you are receiving treatment in an outpatient setting, you must be within an hour of the hospital.
• 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 Multiple Myeloma

Who Is Eligible for CAR T-Cell Therapy for Multiple Myeloma?

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

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

CAR T-cell therapy has a verifiable track record of improving patient outcomes when other treatments have not been successful. Some studies show that up to 50% of patients treated with CAR T-cell therapies have found lasting remission with no additional treatment.

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

Your caregivers will carefully monitor you after your infusion for any side effects. 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

Family members are often the first to notice changes in behavior, such as trouble remembering or confusion. Loved ones and caregivers should report these changes to your treatment team.

How Long Will I Need to Stay in the Hospital?

Your hospital stay may range from one week to two weeks. It may be longer depending on your body’s reaction to the CAR T-cell infusion and possible side effects.

Some patients may be treated in an outpatient setting rather than be admitted to the hospital. Your care team will help determine if you are a candidate for outpatient treatment.

Is CAR T-Cell Therapy FDA Approved for Multiple Myeloma?

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

We use Abecma for CAR T-cell therapy for multiple myeloma. The FDA approved Abecma in March 2021 for the treatment of adult patients with relapsed or refractory multiple myeloma after four or more prior lines of therapy.

We also use Carvykti for both inpatient and outpatient CAR T-cell therapy for multiple myeloma. The FDA approved Carvykti in February 2022 for the treatment of adult patients with relapsed or refractory multiple myeloma who have received at least one prior line of therapy.

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.

View Multiple Myeloma clinical trials.

How Long Does CAR T-Cell Therapy Last for Multiple Myeloma?

There is less data on long-term results for CAR T-cell therapy for multiple myeloma than for other forms of cancer treated with CAR T-cell therapy because multiple myeloma therapies are newer. However, studies on CAR T-cell therapy in other cancers, such as lymphoma, show significant remission rates even five years after the treatment.