CAR T-cell therapy

CAR T-cell therapy is a groundbreaking new treatment that uses a genetically improved version of a cancer patient’s own white blood cells to kill the cancer cells in the patient’s body. University of Iowa Holden Comprehensive Cancer Center is the first provider in Iowa to offer CAR T-cell therapy.

CAR T-cell therapy is a type of immunotherapy. Immunotherapies help the body’s immune system recognize and attack tumor cells. The Food and Drug Administration approved the use of CAR T-cell therapy in 2017 after clinical trials showed encouraging results in patients with two kinds of blood cancer: non-Hodgkin lymphoma in adults and acute lymphoblastic leukemia in children and young adults.

How CAR T-cell therapy fights cancer

One of the ways that cancer cells survive is by avoiding the immune system. CAR T-cell therapy is a way of redirecting the immune system so it is able to find and kill the cancer cells.

This is done by collecting some of the cancer patient’s white blood cells and modifying them in a lab. When these modified cells are returned to the patient’s bloodstream, they recognize and kill the cancer cells.

Boosting our own cancer-killing cells

White blood cells known as T-cells protect the body from disease and infection. CAR T-cell therapy gives T-cells the power to fight cancer.

 

 

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A fake handshake

White blood cells are part of the body’s immune system. What we call white blood cells are actually a number of different kinds of cells that help protect the body against various diseases. One kind of white blood cell is known as a T-cell.

T-cells move through the bloodstream and perform something like a handshake with other cells. Using this handshake, the T-cell is able to tell which cells are normal and which cells are dangerous and should be killed. But cancer cells hide themselves by appearing to be normal cells during these T-cell handshakes.

Turning T-cells into CAR T-cells

In CAR T-cell therapy, T-cells are collected from the patient’s blood and taken to a lab. In the lab, scientists add genes to the T-cells that result in proteins known as chimeric antigen receptors (CAR). This process turns the T-cells into CAR T-cells. CAR T-cells have the power to recognize and kill cancer cells that normal T-cells can’t recognize.

Before the new CAR T-cells are returned to the patient, they are allowed to multiply in the lab into many millions more cells than were originally removed from the patient’s blood.

When the CAR T-cells are returned to the patient’s bloodstream, they begin to find and kill cancer cells. The CAR T-cells also continue to multiply so that even if they kill all of the cancer cells, they will continue to search for new cancer cells to prevent a recurrence of the cancer in the future.

The CAR T-cell therapy process

Patients who receive CAR T-cell therapy progress through multiple steps along their treatment plan. These include:

1. Determining eligibility

The first step in the process is to decide whether a patient is eligible for treatment. Currently, there are two types of CAR T-cell therapy available for two specific types of cancer:

• Adults with certain types of non-Hodgkin lymphoma who have had a relapse or who have received two other kinds of treatment that didn’t work may be eligible for CAR T-cell therapy.
• Children and young adults with acute lymphoblastic leukemia (ALL) that didn’t respond to therapy or has relapsed a second time may also be eligible for CAR T-cell therapy.

Our doctors conduct tests to determine which patients could benefit from CAR T-cell therapy.

2. Collection of T-cells

T-cells are collected from the patient at University of Iowa Hospitals & Clinics using a process called leukapheresis. This is very much like donating blood, but in this process, the blood passes through a machine that collects only T-cells. The rest of the blood is immediately returned to the patient’s bloodstream. The collection takes between three and four hours.

3. Conversion to CAR T-cells

The collected T-cells are sent to a laboratory where they are converted into CAR T-cells. Scientists add chimeric antigen receptors to the T-cells, giving them the ability to find and kill cancer cells. The new CAR T-cells are allowed to multiply, and then they are returned to UI Hospitals & Clinics.

4. Conditioning chemotherapy

The patient receives a low dose of chemotherapy daily for three days before infusion of the CAR T-cells.

5. Infusion

The CAR T-cells are returned to the patient’s bloodstream in an infusion process that takes about 30 minutes.

6. Monitoring

The patient is monitored in the hospital for at least seven days after the infusion of the CAR T-cells. For at least four weeks after that monitoring period in the hospital, the patient must stay within two hours’ travel time of the hospital and return regularly for followup.

Our doctors

Providers for UI Health Care’s CAR T-cell therapy are from the Stem Cell Transplant and Cellular Therapy Program team and include:

 

Margarida Silverman, MD - Clinical Professor of Internal Medicine - Hematology, Oncology and BMT - Director of the Stem Cell Transplant and Cellular Therapy Program

 

Umar Farooq, MD - Clinical Assistant Professor of Internal Medicine - Hematology, Oncology, and BMT

 

Information for referring physicians on CAR T-cell therapy

Holden Comprehensive Cancer Center offers Yescarta (axicabtagene ciloleucel) CAR T-cell therapy for adult patients with large B-cell lymphomas that have failed at least two other kinds of treatment.

Kymriah (tisagenlecleucel) CAR T-cell therapy is available for children and young adult patients with relapsed or refractory acute lymphoblastic leukemia (ALL).