Evaluation
You will meet with Mayo Clinic specialists who will assess your current health and order additional testing to understand if you are eligible for CAR-T cell therapy or if another treatment might be better for you. At least one other person should come with you to all of your appointments.

Most health insurance companies require prior authorization for CAR-T cell therapy. Mayo Clinic's business office works with your insurance company to get written approval and identify plan coverage. Additional treatment steps cannot begin until Mayo Clinic receives approval from your insurance company.

Collection
CAR-T cell therapy involves collecting white blood cells from your own blood through a process known as leukapheresis. During collection, you will be connected to a machine, which will separate your white blood cells from the rest of your blood. The remaining blood is then returned to your body through a vein. The collection process takes up to five hours.

Processing
Once enough white blood cells are collected, the cells are mailed to a special laboratory for processing where the T cells will be genetically modified to activate their ability to kill your cancer. This process can take, on average, several weeks. Most people return home during this phase.

When your cells are ready, you'll return to Mayo Clinic for treatment. 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.

Chemotherapy before infusion
In preparation for your CAR-T cell infusion, you will undergo chemotherapy. Most people start chemotherapy about five days before CAR-T cell infusion. At this time, day-to-day care likely changes to a hospital-based care team. Your care team monitors your health and progress each day.

It is important to understand that during the CAR-T cell therapy process, your health may change in a way that infusing CAR-T cells may no longer be an option. Testing and appointments are needed to make sure you are ready to have the CAR-T cells infused into your body.

Infusion
After chemotherapy, the CAR-T cell infusion can take place. The day the CAR-T cells are put into your body is also called day zero. The infusion of CAR-T cells typically takes 30 to 90 minutes in a process similar to a blood transfusion. Plan for the infusion visit to take up to six hours to allow for care before and after the infusion.

Your CAR-T provider will tell you if you need to stay in the hospital right after the infusion. Caregivers should remain with you 24 hours a day when you are not in the hospital.

Care after infusion
You will be monitored closely by your Mayo Clinic care team for many weeks after the CAR-T cell infusion. You may have one or more physical exams each day at the beginning, and you may be asked to do simple, self-monitoring tasks several times a day.

Most people have a reaction to CAR-T cells that requires them to stay in the hospital for days to weeks for monitoring and treatment.

Returning home
You will meet with your CAR-T cell specialist to understand the effect of the therapy and develop a plan for the future and returning home. Once your health is stable, your care will transfer back to your local care provider.

In general, you will need to return to Mayo Clinic frequently for appointments during the first year after CAR-T cell therapy. Ongoing care may be needed for months to years after CAR-T cell therapy.