Common CAR T-Cell Therapy Side Effects
- Chimeric antigen receptor (CAR) T-cell therapy is a treatment for multiple myeloma, and it can cause side effects.
- One of the most common is a collection of flu-like symptoms known as cytokine release syndrome, or CRS.
- This treatment can also affect the brain, causing confusion and difficulty speaking.
- Doctors closely monitor for these and other side effects after treatment, and have therapies to manage them.
First, remember that this treatment has been well-studied in clinical trials. And it wouldn't have been approved if the FDA felt it was unsafe. But because some of the side effects can be pretty intense, you may need to stay in the cancer center for a period of time so that your treatment team can monitor you. "For the next couple of days, you’ll be watched really closely," says Dr. Nina Shah, a hematologist at UCSF Medical Center.
Read MoreThe ‘Worst Flu’ You've Ever Had
Between 3 and 14 days after your treatment, you'll most likely develop a collection of symptoms known as cytokine release syndrome, or CRS. "This basically feels like the worst flu you ever had," Dr. Shah says. Expect symptoms such as chills, fever, extreme fatigue and joint or muscle aches. Related: CAR T-Cell Therapy: What You Should Know About Side EffectsWhat's happening inside your body is that the CAR T-cell therapy is making your immune system think you have an infection or other problem. Your immune system releases massive amounts of cytokines in response. These chemicals normally help direct your body's immune attack, but in large quantities, they can trigger lots of inflammation in your body.
What can feel pretty miserable is actually a good sign. "This usually means that the cells that were infused are having a party," says Dr. Shah. "They’re recognizing your myeloma, and they’re trying to eat away at it.”
If you've looked up CRS online, you might have seen that it can damage organs. But in reality, some of the dangers researchers were concerned about in the clinical trials of this treatment are very treatable. "Most people are successfully treated with a drug called tocilizumab [brand name: Actemra], and this will be available at your center to treat your CRS if it’s becoming dangerous," Dr. Shah says.
CAR T and the Brain
Another worry is that inflammation caused by this treatment can be harmful to nerve cells in the brain, a side effect your doctor might refer to as "neurotoxicity." Signs include drowsiness, trouble speaking or understanding others, loss of balance and changes in consciousness. "You might be feeling a little confused, for example, or not quite right," Dr. Shah explains.
She says your doctor and nurses will ask you a lot of questions to assess your mental state. They might sound like a broken record, asking the same questions over and over again, but the purpose is to make sure you're alert and fully responsive. "If we sense that you’re starting to have confusion, we may… give you steroids to help calm down the inflammation," she adds.
The Recovery Process
Don't expect to go home and get back to normal right after CAR T-cell therapy. Recovery is a process.
"You’ll have a lot of blood draws, a lot of labs, a lot of visits from doctors," Dr. Shah says. "All of this is to keep you safe. And eventually, you’ll be able to do a lot of this as an outpatient, as you recover from this process."
Considering CAR T-Cell Therapy
CAR T-cell therapy is being offered at more cancer centers. If it becomes available to you, take the time to do your research. Read up on this treatment, and learn how it has helped other people with your cancer.
"Get any information that you need," Dr. Shah says. Come back to your doctor's office prepared with all the questions you'll need to ask to consider whether this is a possible therapy for you.
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