Below are answers to some of the most frequently asked questions about CAR T-cell therapy.
If you’ve been diagnosed with cancer, would like a second opinion or would like to speak with a cancer specialist about immunotherapy options, please call The James Line at 800-293-5066 or 614-293-5066 to make an appointment. For other questions about our Cellular Therapy Program, please contact one of our specialized cell therapy coordinators at 614-688-7868.
What is Chimeric Antigen Receptor or CAR-T?
CAR T-cell therapy is a type of cellular therapy – a new, proven, leading-edge approach to immunotherapy available right here at the OSUCCC – James.
Called CAR-T for short, this living-drug therapy involves using a patient’s own white blood cells: experts remove white blood cells (called T cells) from the patient’s blood, then in the lab, place what’s called a Chimeric Antigen Receptor (or CAR) on the cells’ surface to retrain them to identify a specific cancer-signal on that surface. The specialists then infuse the CAR T-cells back into the patient, where these modified cancer-fighters target and attack only the cancerous cells.
How do you treat the patient with these cells?
The OSUCCC – James experts collect the patient's T cells in an outpatient setting, and the collection process can take a few hours. Once we receive the modified cells back from the lab, the patient comes in for a round of chemotherapy to prepare for infusion.
Most patients are admitted to the hospital to receive the CAR T-cells. Patients who are admitted will remain in the hospital for at least seven days so they can be carefully watched for any signs of side effects. If a patient is infused in the outpatient clinic, the OSUCCC – James team schedules follow-up appointments every day for at least seven days to monitor for serious side effects.
Who is eligible for CAR-T therapy?
Patients are eligible if they:
- have an aggressive form of diffuse large B-cell lymphoma (DLBCL) that has not responded to treatment or that has come back after at least two other kinds of treatment;
- have primary mediastinal B-cell lymphoma;
- have follicular lymphoma that has transformed to a more aggressive type;
- are up to 25 years old and have acute lymphoblastic leukemia (ALL) that has not responded to treatment or that has come back after a previous treatment
What do I do if I think I’m a candidate for cell therapy?
Talk with your doctor to see if he/she agrees that you might be a candidate. Our Cellular Therapy Program specialists will be happy to work with your doctor’s office and review your records to see if you might be eligible for this therapy. If you have questions, please call The James Line at 800-293-5066 or one of our specialized cell therapy coordinators at 614-688-7868.
How common are these types of cancer listed above?
No cancer is ever common or routine. Diffuse large B-cell lymphoma (DLBCL), however, is the most frequently diagnosed type of Non-Hodgkin's lymphoma (NHL) in adults. These cancers begin in certain cells of the immune system. DLBCL represents approximately one in three newly diagnosed cancer cases, with approximately 72,000 cases diagnosed each year in the United States.
Acute lymphoblastic leukemia (ALL) is the most frequently diagnosed cancer in children and adolescents, usually between the ages of two and five years old. It is responsible for one in five diagnoses annually, and accounts for more than 3,000 childhood cancer diagnoses per year.
What are the side effects of cell therapy?
The most severe side effect is cytokine release syndrome (CRS). CRS is a response to the CAR T-cells attacking the tumor cells and signaling to other immune cells to help. CRS can cause high fever and flu-like symptoms. Neurologic problems, including confusion, trouble finding words, tremors, trouble communicating and seizures also can happen and may be severe. Both CRS and neurologic problems can be fatal or life threatening.
Other side effects include serious infections, low blood cell counts and a weakened immune system. Side effects usually appear in the first week or two after infusion, which is why patients are closely monitored for the first seven days and continue to be monitored thereafter. It is possible to develop side effects later, which may require admission to the hospital for further monitoring and treatment. For monitoring purposes, patients must also be able to stay within a two-hour drive to the OSUCCC – James for the first four weeks after infusion.
Are there long-term side effects of cell therapy?
Some patients may have low blood counts or weakened immune systems. The CAR T-cells affect the immune system’s cells, which make antibodies that help fight infection. Patients may require IVIG, or antibodies from donors, to help fight infections after treatment.
Some patients may also need blood transfusions until their blood counts go back to normal after treatment.
Has CAR-T been used to treat other cancers?
The OSUCCC – James’ success in personalized cellular therapy goes beyond leukemia and lymphoma. We have several clinical trials available to develop and test cancer vaccines as well as to use CAR-T cell therapy or other cell-based therapies in other types of blood cancers and solid tumors. Learn more: Cellular therapy clinical trials.
Does insurance cover this treatment?
CAR T-cell therapies that have been approved by the U.S. Food and Drug Administration (FDA) may be covered or reimbursed by your insurance. It is important and necessary to speak with your insurance provider prior to receiving treatment to make sure you understand your coverage. The OSUCCC – James has a team of trained financial counselors who will also work with patients and their insurance providers to understand what treatment options are available.
All referrals begin with prior authorization for a consult visit with a physician. Even if patients are not eligible for CAR T-cell therapy, other treatment options may be available, including clinical trials.
As a provider, how do I refer a patient?
If you are a provider who would like to schedule a new patient appointment, please call:
How quickly will I be seen for CAR T-cell treatment?
The OSUCCC – James works diligently to be able to offer convenient physician-consultation appointments within one to two weeks from the time we are called. Once you have been evaluated and determined to be eligible for CAR T-cell therapy, our cellular therapy coordinator will work with you to schedule the blood cell collection and other visits that will be necessary for treatment.
Do I need a caregiver?
You may find that things you can normally do for yourself are not as easy or cannot be done safely for a while after receiving CAR T-cell therapy. A caregiver helps you get through this process by providing physical and emotional support.
Some tasks a caregiver might do for you:
- Keep track of medications and monitoring for changes in your health
- Attend healthcare appointments with you and advocate for your care
- Grocery shop, prepare meals or do housekeeping tasks
- Be a support system and provide you with encouragement during your treatment
- Be there to call for help if needed
What can I expect after CAR T-cell therapy?
After CAR-T cell therapy, you'll have appointments with the OSUCCC – James cell therapy team of experts as frequently as every month. To start, your doctor will schedule scans to assess your progress at three months and again at six months. The appointments will become less frequent as your health improves and there are fewer signs of disease.
If you were referred by a doctor outside of the OSUCCC – James, we will coordinate with your doctor to transition care back to that physician at the appropriate time.
How long will I need to stay in Columbus for treatment?
You may need to make several trips to the OSUCCC – James to determine your eligibility for the therapy as well as to meet with a doctor to make a personalized plan for your care. If you are eligible for treatment, you will need to stay nearby for at least four weeks after you receive the treatment.
Since I will be in Columbus for an extended period of time, what is there to do? How do I get there? Where do I stay?
We want your time in Columbus to be as enjoyable as possible. Our Patient and Visitors guide provides information and a variety of services to help.
Why choose the OSUCCC – James for CAR T-cell therapy?
The internationally recognized specialists at the OSUCCC – James are transforming the way cancers are prevented, detected, treated and cured. We know there is no routine cancer, and our experts believe the best way to treat patients and manage their disease successfully is to deliver the latest, most effective treatments available.
The central focus of our care is our patients and their families. We provide relationship-based care, and we include our patients in every step of the care process to ensure the patient’s needs always come first come first.
Additionally, our Cellular Therapy Program specialists consult with their colleagues about every patient’s condition and make treatment recommendations based on their vast and collective experience as well as proven, evidence-based medicine.
The OSUCCC – James is one of very few medical centers nationwide with experts trained and certified to manage CAR T-cell therapy patients, and one of even fewer sites that offers both FDA-approved CAR-T therapies outside of a clinical trial.