Sikander Ailawadhi, M.D., Hematologist-Oncologist, CAR T Specialist: CAR T or Chimeric antigen receptor T-cell therapy is a kind of immunotherapy. It involves a process in which the patients white blood cells or T cells are collected. They are genetically modified so that their ability to seek and kill the cancer cells is activated. So once these T cells are collected, they are genetically modified in the laboratory, then they are multiplied to increase their numbers. After these numbers are increased, these modified T-cell are given back to the patient so that now they have the ability to seek and kill the cancer cells.
CAR T-cell therapy is available for several kinds of cancers, including acute lymphoblastic leukemia, multiple myeloma, and several kinds of lymphomas, including follicular lymphoma, mantle cell lymphoma, and diffuse large B-cell lymphoma. But it is important to remember that CAR T-cell therapy may not be applicable for all patients or all stages, even for these diagnoses.
It is important to discuss this with a specialist CAR T Center and CAR T-cell provider, to be able to know whether this may be applicable to you or not. It is also important to remember that CAR T-cell therapy is being developed and evolved for many different types of cancers, sometimes on clinical trials.
It is important for everybody to know what Mayo Clinic offers and why it is important to consider Mayo Clinic in their CAR T-cell decisions and journey. Mayo Clinic has been named one of the top most cancer centers in the country for many, many years. Mayo Clinic is also consistently rated the top hospital in the United States. We specialize in and offer all the available CAR T-cell therapies and we also have several clinical trials and CAR T-cell treatment available. I would like our patients and whoever wants to learn about CAR T to be aware that we have a large multidisciplinary team at all of our sites, that is specifically dedicated to the care of patients who are either candidates for CAR T or are receiving CAR T-cell therapy. Our outcomes, our results are amongst the best results from any center in not only the country, but the world.
If a patient or their loved one feel that they are eligible for CAR T-cell treatment, they should first discuss with their local doctor who is providing them with the treatment and then they can connect with or reach out to a specialized CAR T center like Mayo Clinic. That is when we will connect you with a specialist who will review your case, your history, your records, and be able to recommend whether CAR T-cell therapy would be an appropriate option for you or not.
It's also important to know that sometimes patients may not even be aware that CAR T-cell treatment is the right approach for them. In such cases, if we or our specialists feel that this is the most appropriate approach or at least a possibility, we may actually offer it to you.
It is very important for patients and their caregivers to know what to expect during CAR T-cell therapy, because it can be a long and sometimes complicated process. First of all, our specialists get the patient through tests to make sure that their body, their general health, and their cancer are appropriate for CAR T-cell treatment. Then, a patient comes for an outpatient visit in which they are connected to a machine. This machine collects their white blood cells or T-cells, and this process can take about four to five hours on a given day. This is all done as an outpatient. After that, these T cells are sent to the laboratory to be genetically modified so that they can then have the ability to seek and kill the cancer cells. But it is important to note that this manufacturing process can take a few weeks. During that time, the patient may need more chemotherapy to keep their cancer controlled and quiet. Once the cells have been manufactured and they're received back at our hospitals, we will then bring the patient back, they're given more chemotherapy as an outpatient, which is given over three days to prepare their body to receive these new CAR T-cells. After the three days of chemotherapy, there are a couple of days of rest. Then the patient is admitted to the hospital where the CAR T-cells are given to them, just as an IV infusion and that infusion itself takes about 30 to 90 minutes.
It is very important for patients and caregivers to know what to expect actually after the CAR T-cell have been given to them. Generally at that point, there will be several weeks of intensive monitoring and follow-up. After the CAR T-cell treatment, your doctor, your CAR T specialist will tell you whether or not you need to stay in the hospital and for how long. Whether a patient is in the hospital setting or as an outpatient, we want patients to stay close to the Mayo Clinic Hospital for several weeks after the CAR T-cell treatment. And when I say close that is somewhere within 30 minutes drivable distance. Patients will undergo several frequent tests including blood work, imaging, et cetera. They will also get frequent physical examinations and sometimes they will be asked to do some simple tasks to make sure that their body and brain function is normal. At that point. when all of this follow-up is going on, roughly around 30 days or so after CAR T-cell treatment, the body has recovered enough that we are able to discharge the patient to be able to go back home. And at that time we will make a detailed plan and hand over to your local doctors so that you can continue your care over there. Of Course, we will tell you when you may need to come back to Mayo Clinic for any follow-up visits or tests.