CAR T-Cell Therapy: A Step-By-Step Guide to Having This Breakthrough Treatment

"CAR T-cells are cells that we can take from your body and engineer to specifically recognize the multiple myeloma, and to kill those cells," says Dr. Nina Shah, hematologist and professor of clinical medicine at the University of California, San Francisco (UCSF).

Most multiple myeloma cells have a protein on their surface called B-cell maturation antigen (BCMA). Abecma attaches to BCMA, which causes the cells to die. In studies, the treatment produced response rates of 70% to 90% or even higher, that lasted for an average of nearly 11 months.

How It Works

Getting CAR T-cell therapy is different from having traditional cancer treatments such as chemotherapy and radiation. For one thing, it's a form of immunotherapy, which means that it retrains your own cells to find and kill cancer. T cells are immune cells that help your body fight off foreign and dangerous invaders, such as cancer.

These cells reside in your blood. So to start this treatment, some of your blood will be removed in a process known as apheresis. "Your cells are going to be taken out of your body by a blood draw," Dr. Shah says. "They will hook you up to this apheresis machine, and you will likely have an IV placed, and then you will have blood taken out. And that will be a couple of hours process." They'll filter out the cells they need, and return the rest of your blood to you.

Now you will have to wait for a couple of weeks. "Those cells need to be shipped off and engineered so that they recognize your multiple myeloma cells," Dr. Shah says. At the lab, your cells are genetically altered to express a new protein called chimeric antigen receptor (CAR) on their surface. This CAR receptor will seek out the BCMA target on the surface of your cancer cells to attack them. Then the cells are multiplied before they’re returned to you.

While you wait, your doctor might consider giving you what is called "bridging chemotherapy." This is chemotherapy given between the blood draw procedure and the infusion of CAR T-cells. It's meant to control your disease until your T cells are ready. "You may get steroids or chemo that you’ve already gotten before, but only for a few weeks, because we want to make sure that you’re nice and pristine before those T cells come back," Dr. Shah adds.

Returning Your T Cells To You

Finally, your genetically modified T cells will be shipped back to your center. You'll get three days of chemotherapy with the drugs fludarabine and cyclophosphamide, and then you'll have two days of rest. Finally, your T cells will be infused through an IV. After the last step, your doctor will monitor you very carefully for potential side effects from the treatment.

Related: Cytokine Release Syndrome and CAR T-Cell Therapy: Understanding the Risks

CAR T-cell therapy can cause a number of side effects. One of the main risks is cytokine release syndrome (CRS). As the CAR T-cells multiply, they release inflammatory chemicals called cytokines. These chemicals can cause symptoms such as a high fever, fatigue, chills and difficulty breathing. Other potential risks are allergic reactions and an increased likelihood of infections.

CAR T-cell therapy can be an intensive process, but it can produce significant and long-lasting responses in people who haven't improved on other treatments. And that could make a dramatic difference in the lives of some people with multiple myeloma.

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