CAR T-Cell Therapy

What is CAR T-cell Therapy?

CAR T-cell therapy is short for chimeric antigens receptor T-cell therapy, and it’s a new, proven approach to immunotherapy available right here at the OSUCCC – James.

This type of cellular therapy uses a patient’s own white blood cells to target cancer cells, and extensive clinical trials have proven that CAR T works quickly — and often with fewer side effects than traditional cancer treatments like chemotherapy and radiation. Patients have even described feeling these modified, retrained cells attack their cancer almost immediately after infusion, and many patients have experienced complete remission in a few months.

As one of the highest volume cellular therapy sites in the United States, our teams of cancer specialists and subspecialists administer CAR T-cells safely and effectively. The OSUCCC – James has been an early site for CAR T-cell research trials, and we continue to enroll patients in cellular therapy clinical studies.

The OSUCCC - James BMT and CAR T-Cell Therapy Outpatient Program

CAR T-cell and bone marrow transplant therapies are often given in a hospital where you will have to stay anywhere between one and three weeks depending on the type of procedure you receive. If you are a candidate for either of these treatment options, you may be able to receive your recommended treatments on an outpatient basis should you meet specific criteria. The OSUCCC – James BMT and CAR T-cell Therapy Outpatient Program is the first of its kind in Central Ohio for cancer patients.

How does CAR T-cell therapy work?

Each patient’s cancer has a specific antigens. As with other cell therapies, with CAR T therapy we teach the immune system how to find these antigens — like fitting a key to a lock — so that the immune cells can bind to the cancer cells and signal their destruction. After identifying the antigens involved in an individual patient’s cancer, the steps for CAR T-cell therapy include:

1. A specially trained expert from the OSUCCC – James removes white blood cells, known as T-cells, from the patient’s blood.
2. In a lab, the specialist then places a Chimeric Antigen Receptor (or CAR) on the surface of the T-cells.
3. This T-cell is now called a CAR T-cell and it’s been retrained to look for the cancer’s specific antigen. This re-engineered cell is then multiplied in the lab to increase its numbers.
4. After a round of chemotherapy to reduce the amount of remaining white blood cells in the body so there’s room for new cells, the specialist then infuses the multiplied CAR T-cells back into the patient.
5. These modified cancer fighters begin to target and attack only the cancerous cells.

Receiving CAR T-cell therapy

We use infusion for CAR T-cell therapy. Although infusion only happens once, preparing for it can take several weeks. Here’s what the process looks like for most people:

• Patients will work with the OSUCCC – James Cell Therapy Program to complete all required lab tests and health checkups prior to the procedure. We will also confirm coverage with each patient’s insurance company.
• We collect T-cells first by drawing blood, usually from a vein in the arm. This blood will be run through an apheresis machine to separate out the white blood cells. The rest of the blood is then put back into your body through a different tube.
• The T-cells that we collect will be converted into CAR T-cells, which we’ll then allow to multiply in the lab. It can take two to four weeks to grow enough of these new cancer-fighting cells.
• Before the patient’s therapy infusion, they may undergo chemotherapy to create room in their system for the new healthy CAR T-cells.
• During chemotherapy and infusion, patients will stay at the OSUCCC – James. The infusion itself happens in a warm, comfortable room and patients can have a caregiver with them for support.
• Because treatment is complex and may have side-effects, patients are closely monitored and may have to stay in the hospital for at least seven days after CAR T-cell infusion.

Care following CAR T-cell therapy

After leaving the hospital, patients will have follow-up appointments with the OSUCCC – James Cell Therapy Program team as often as every month. Patients will continue to be seen by their primary oncologist as well as our pharmacy and support care teams and other medical experts as needed.

In addition, scans are done to check your progress at three and six months after infusion. These appointments will then become less frequent as health improves and there are fewer signs of disease.

Patients often need additional help to complete even simple daily tasks for a while after CAR T-cell therapy. For example, it can be eight weeks until it’s safe to drive. This is normal with cell therapies, but we can help with resources if needed, and a caregiver can help patients through this process by providing physical and emotional support.

If a patient was referred by a doctor outside of the OSUCCC – James, our team will coordinate with the referring doctor to transition care back to that physician at the appropriate time.

CAR T-cell therapy side effects

As with any cancer treatment, there are side effects that can be associated with CAR T-cell therapy, which is why all OSUCCC – James care team specialists are highly trained in the evaluation and treatment of side effects associated with this therapy. Most patients experience moderate side effects, which are usually completely reversible.

While some can be serious, most patients experience moderate side effects, which are usually completely reversible.

The most severe side effect is cytokine release syndrome (CRS), which is a response to CAR T-cells attacking 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 can also occur and may be severe.

The OSUCCC – James Intensive Care Unit and The Wexner Medical Center Emergency Department work collaboratively with the Cellular Therapy Program when patient need care in those areas Some patients may have low blood counts or weakened immune systems. Additionally, some patients may need blood transfusions until their blood counts return to normal after treatment. 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.

Other side effects can include:

• Fever (100.4°F/38°C or higher)
• Difficulty breathing
• Chills or shaking chills
• Confusion
• Dizziness or lightheadedness
• Nausea, vomiting, or diarrhea, which may be severe
• Fast or irregular heartbeat
• Fatigue or weakness which may be severe

Referrals and appointments

The OSUCCC – James medical experts include world-renowned cancer specialists, subspecialists and super subspecialists in cancer prevention, detection, diagnosis and treatment.

To make an appointment (or as a provider, to refer a patient), please call The James Line at 614-293-5066 or 800-293-5066. Specialized cell therapy coordinators are also available to answer questions at 614-688-7868.

For international physicians or patients:

The OSUCCC – James has a Destination Medicine Global Health Care team that can answer questions or coordinate a remote medical consultation. You can reach us 24 hours a day, seven days a week.

Call 001-614-685-5422 or email us at destinationmedicine@osumc.edu.