CAR-T CELL THERAPY FOR HAEMATOLOGICAL CANCERS

In recent years, immunotherapy has emerged as a promising approach to cancer treatment. One innovative treatment that's making waves is CAR-T cell therapy, which harnesses the power of the immune system to fight haematological malignancies. This groundbreaking treatment involves removing T cells from a patient's blood and modifying them in a laboratory to produce chimeric antigen receptors (CARs). These CARs enable T cells to recognize and destroy cancer cells. The modified T cells are then infused back into the patient's bloodstream, where they can seek out and eliminate cancer cells.

How does CAR-T cell therapy work ? 

In CAR T-cell therapy, healthcare providers introduce a new gene into your T cells that changes your cells so they can do more to detect and kill cancerous cells. In some cases, CAR T-cell therapy can cure blood cancer. Other times, it helps people with certain blood cancers live longer.

To grasp how CAR T-cell therapy works, it's essential to understand the role of T cells in the immune system. T cells are a type of white blood cell that patrols the body for foreign invaders, including cancer cells. They do this by recognizing proteins called antigens on the surface of abnormal cells. Each T cell has a unique receptor that can identify specific antigens. When a T cell receptor recognizes an abnormal cell, it becomes activated and launches an attack, destroying the cell and triggering other immune responses.

However, sometimes T-cell receptors fail to detect cancerous cells. This is where CAR T-cell therapy comes in. This innovative approach involves modifying a patient's own T cells to recognize a specific antigen on cancer cells. Scientists achieve this by introducing a lab-made gene that creates a chimeric antigen receptor (CAR). The modified T cells, now called CAR T cells, are then grown and multiplied in large quantities.

Once infused into the patient's bloodstream, the CAR T cells use their receptors to detect and destroy cancerous cells. The CAR T cells continue to multiply, providing a long-term supply of cancer-fighting cells. This unique ability to adapt and evolve makes CAR T-cell therapy a type of "living drug," offering a promising new approach to treating cancer.

Procedure Details

What happens before I have CAR T-cell therapy?

First, you donate white blood cells through a procedure called leukapheresis. In leukapheresis,  a machine draws some of your blood, extracts your white blood cells and then returns the remaining blood to your body. Typically, your providers will insert a central venous catheter to remove and return your blood.

Next, your white blood cells are quickly transported to the facility where scientists will turn your cells into CAR T cells. This process can take between two and four weeks.

Depending on your situation, you may have chemotherapy or radiation therapy after leukapheresis but before you receive CAR T cells. Your healthcare provider may call this bridging therapy. These treatments manage blood cancer during the time it takes to produce and grow enough CAR T cells to treat your condition.

When it’s time for you to receive your new cells, you’ll undergo lymphodepleting chemotherapy. This treatment keeps your body from rejecting the CAR T cells.

What happens during CAR T-cell therapy?

The actual treatment involves receiving CAR T cells via infusion. CAR T-cell infusion takes between five and 30 minutes and is done via an intravenous line (IV). You may need to stay in the hospital during the procedure. The infusion process is like a blood transfusion.

1. The CAR T cells are stored in a medical bag until they’re needed.

2. Your cell therapy nurse connects the bag containing CAR T cells to an intravenous line.

3. The new cells flow into your bloodstream.

What happens after CAR T-cell therapy?

This treatment may cause serious side effects, so your provider may recommend that you stay in the hospital immediately after treatment. Depending on your situation, including side effects, you may need to stay in the hospital for one to two weeks. After that, you should plan to be within driving distance of your treatment center for the first month after treatment. You’ll also need:

• Someone with you 24 hours a day in case you experience side effects.

• Someone to handle driving for you for two months after you receive your T cells.

What conditions can CAR T-cell therapy treat?

Right now, CAR T-cell therapy is an option to treat some blood cancers when other treatments aren’t effective or the condition comes back. Those blood cancer types include:

• B-cell acute lymphoblastic leukemia (ALL)

• Diffuse large B-cell lymphoma

• Follicular lymphoma

• High-grade B-cell lymphoma

• Mantle cell lymphoma

• Multiple myeloma

• Primary mediastinal large B-cell lymphoma.

What are the benefits and risks of CAR T-cell therapy?

The benefits of CAR-T cell therapy are undeniable. It has shown remarkable success in treating blood cancers, including relapsed or refractory large B-cell lymphoma, follicular lymphoma, mantle cell lymphoma, and acute lymphoblastic leukemia. This treatment offers new hope for patients who have not responded to other therapies. In fact, studies have shown that CAR-T cell therapy can achieve complete remission in some patients, allowing them to live longer and improve their quality of life.

However, CAR-T cell therapy is not without its risks. It can cause severe side effects, including cytokine release syndrome (CRS) and immune effector cell-associated neurotoxicity syndrome (ICANS). CRS occurs when the CAR-T cells multiply in the body and cause a massive release of cytokines, leading to symptoms such as fever, fatigue, and nausea. ICANS, on the other hand, can cause neurological symptoms such as confusion, seizures, and brain swelling. Fortunately, guidelines and protocols are in place to manage these side effects, and researchers are working to develop new strategies to minimize their impact.

Despite the potential risks, CAR-T cell therapy holds great promise for patients with blood cancers. Ongoing research aims to expand its applications and improve its safety and efficacy. For example, researchers are exploring the use of CAR-T cell therapy in combination with other treatments, such as chemotherapy and radiation therapy. They are also investigating new ways to modify T cells to make them more effective at recognizing and destroying cancer cells.

As CAR-T cell therapy continues to evolve, it has the potential to revolutionize the way we approach haematological malignancies. With its innovative approach and promising results, CAR-T cell therapy is an exciting development in the field of cancer treatment. As researchers continue to push the boundaries of what is possible with this therapy, patients with blood cancers may soon have new hope for a cure.