CAR-T Cell Therapy Program

What is chimeric antigen receptor (CAR)-T cell therapy?

CAR-T cell therapy is a kind of immunotherapy. It involves harnessing the power of a person's own immune system by engineering T cells to recognize and destroy cancer cells.

Will this work for my type of cancer?

The FDA-approved conditions for CAR-T cell therapy include:

• B-cell precursor acute lymphoblastic leukemia (ALL), in people up to 25 years of age
• Diffuse large B-cell lymphoma (DLBCL)
• Primary mediastinal large B-cell lymphoma
• Large B-cell lymphoma transformed from follicular lymphoma
• High grade B-cell lymphoma
• Aggressive B-cell lymphoma not otherwise specified (NOS)
• Mantle cell lymphoma
• Follicular lymphoma
• Multiple myeloma

How do I know if I'm eligible for CAR-T cell therapy at Mayo Clinic?

In order to be eligible for CAR-T cell therapy, typically you must have already received standard of care chemotherapies. Mayo Clinic doctors will evaluate you to understand how to best treat your disease and to understand if CAR-T cell therapy may be an option.

What should I do if I think I or a loved one is eligible for treatment?

If you think you or a loved one is eligible for CAR-T cell therapy at one of Mayo Clinic's three locations, please call the phone number below to request an appointment at the location you are interested in seeking care at. Our appointment staff will work to find the specialist who can best address your questions and needs. Be sure to mention that you are interested in CAR-T cell therapy to ensure your request is routed correctly.

• Minnesota: 507-284-5096
• Arizona: 480-342-4800
• Florida: 904-956-3309

Who can my non-Mayo Clinic doctor talk to at Mayo Clinic about CAR-T cell therapy?

Mayo Clinic hematologists are happy to discuss possible referrals with doctors and allied health staff outside of Mayo Clinic. Your doctor needs to mention that you are interested in understanding whether CAR-T cell therapy may be appropriate for you. Patient appointments are scheduled Monday through Friday from 8 a.m. to 5 p.m. local time at each campus. Consultations with Mayo doctors are also available during these hours.

Minnesota: Have your doctor call the Hematology Department directly at 507-284-5096 to request an appointment for a consultation. Your doctor can also contact the Referring Provider Service (toll-free) at 800-533-1564.

Arizona: Have your doctor call the Hematology Department directly at 480-342-4800 to request an appointment for a consultation. Your doctor can also contact the Referring Provider Service (toll-free) at 866-629-6362.

Florida: Have your doctor call the Hematology Department directly at 904-956-3309 to request an appointment for a consultation. Your doctor can also contact the Referring Provider Service (toll-free) at 800-634-1417.

How soon can I expect to get an appointment at Mayo Clinic for CAR-T cell therapy?

Mayo Clinic is typically able to offer you an appointment within one to two weeks with a provider who specializes in the type of cancer or medical condition you have. Once you have been evaluated by the necessary specialists and determined to be eligible for CAR-T cell therapy, Mayo Clinic will work with you to schedule treatment. The appointment time depends on several factors, including your condition, laboratory capacity and the number of people seeking this treatment.

How much does CAR-T cell therapy at Mayo Clinic cost?

CAR-T cell therapy is a newer type of cancer treatment that may be more expensive than other therapies. Not all insurance policies cover CAR-T cell therapy. The out-of-pocket cost for CAR-T cell therapy varies, depending on your insurance coverage for services at Mayo Clinic as well as for CAR-T cell therapy itself.

Will my insurance cover CAR-T cell therapy?

In order to determine if your insurance company will cover CAR-T cell therapy, please call your insurance company and ask the following two questions:

• Does my insurance plan include coverage at the Mayo Clinic location I am seeking treatment at?
• Does my insurance plan provide coverage for CAR-T cell therapy? If not, is there a review process?

We will work with you and your health insurance company to determine if CAR-T cell therapy will be covered, if that is the recommended treatment. This includes any appeals process with the insurance company.

Who do I need to bring with me during my CAR-T cell therapy?

During your CAR-T cell therapy, you may not be able to do things you can normally do for yourself well or safely. A caregiver helps you get through this process. The caregiver provides physical and emotional support and, sometimes, acts as an advocate for you.

Some tasks a caregiver might do for you:

• Oversee your daily needs such as keeping track of medications, nutrition and monitoring for changes in your health
• Help you to stay organized and manage details
• Attend all your health care appointments with you
• Communicate with the CAR-T cell therapy team about your care
• Grocery shop, prepare meals or do housekeeping tasks
• Support you in your choices
• Be there to call for help if needed

The caregiver also needs to be your cheerleader, someone to give you words of encouragement, keep you going, cheer you up, make you laugh and help you get through it all.

How long will I need to be near Mayo Clinic for treatment?

Once you have been identified as a candidate for CAR-T cell therapy, you may need to make several trips to Mayo Clinic to determine your eligibility for the therapy as well as to meet with a doctor to make a plan for your care.

Evaluation: For this initial evaluation, plan on staying near Mayo Clinic for up to five business days in order to complete needed tests.

Collection: Depending on the timing of insurance approval, the collection may occur as soon as the week following the completion of evaluation. The collection process will take a minimum of two days.

Processing: Most people return home during this phase.

Chemotherapy before infusion: From this point on, plan on being at Mayo Clinic for many weeks depending on your medical needs. During this time, you'll need to stay within 30 minutes of Mayo Clinic.

Infusion: The infusion of CAR-T cells typically takes 30 to 90 minutes. However, plan for the infusion visit to take up to six hours to allow for care before and after the infusion.

Care after infusion: You will be monitored closely for many weeks after the CAR-T cell infusion.

What can I expect after CAR-T cell therapy?

Initially, after your CAR-T cell therapy, you will have appointments with the Mayo Clinic team as frequently as every month. As your health improves and there are fewer signs of disease, the appointments will become less frequent. Anticipate at least annual visits to Mayo Clinic.

Because CAR-T cell therapy is a form of gene therapy, the FDA requires a 15-year monitoring.

What is it like at Mayo Clinic? How do I get there? Where do I stay?

We want to help make your travel to Mayo Clinic as easy as possible. We provide information and a variety of services to help.

Minnesota: Mayo Clinic's campus in Rochester, Minnesota, has free Concierge Services to help plan your stay, and fee-based Patient Travel Services.

Why choose Mayo Clinic for CAR-T cell therapy?

At Mayo Clinic, the needs of the patient come first. The CAR-T Cell Therapy Program doctors and other specialists consult with their colleagues about your condition and recommend treatment options based on their experience and evidence-based medicine. Mayo Clinic's experts have treated people in the landmark clinical trial that led to FDA approval of this innovative therapy. This program is one of a very few such programs at select medical centers with experts trained and certified to manage CAR-T cell therapy as clinical practice.

Questions to ask your doctor

• How is the treatment given and what is the procedure like?
• Is a hospital stay required before, during or after treatment?
• How many treatments are needed and how long will they take to be given?
• What are the risks and side effects of treatment?
• What is the cost for treatment? Is it covered by insurance?
• What are the alternatives?
• What are the chances of remission or cure?