Steps Involved in CAR T-cell Therapy

The first step in CAR T-cell therapy is to confirm that you are a good candidate for the treatment.

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CAR T-cell therapy usually takes four-to-eight weeks from the collection of T-cells through follow-up care after the cells are infused. 

There are several steps involved in CAR T-cell therapy:

  • collecting your T-cells
  • converting your T-cells into CAR T-cells at a special laboratory
  • growing hundreds of millions of your CAR T-cells in the laboratory
  • preparing your body for the CAR T-cells, usually with chemotherapy
  • infusing the CAR T-cells into your body
  • monitoring you for complications after treatment

Are you healthy enough for CAR T-cell therapy?

Prior to collecting your T-cells, you will undergo a series of tests to confirm you are healthy enough for CAR T-cell therapy. These tests may include:

  • blood counts
  • tests for infection
  • pulmonary function tests to determine the health of your
  • lungs
  • echocardiogram to assess your heart’s health
  • MRI to determine whether your disease has spread to the
  • brain
  • blood tests to assess kidney and liver function 
  • bone marrow tests
  • CT or PET/CT imaging to determine where the disease is located in your body
  • a biopsy to confirm your diagnosis
  • a spinal tap to determine if your disease has spread to your central nervous system

Emotional and Financial Concerns

You may have a consultation with a social worker or psychologist to address any emotional concerns you have. The social worker will also discuss the important role of your family member or friend who will serve as your caregiver. You may be invited to attend a class for CAR T-cell recipients and caregivers to help you better understand what to expect during and after treatment.

You may also meet with a financial counselor to discuss how to manage expenses, including incidental expenses such as transportation, parking, meals and lodging, particularly if your treatment center is far from home.

How are T-cells collected?

The process used to collect your T-cells is called leukapheresis. The collection usually takes place in the outpatient clinic and can take four-to-six hours.

During your T-cell collection:

  • you will sit in a comfortable chair or bed
  • blood will be withdrawn from you and passed through a machine that separates out your T-cells
  • the rest of your blood product will be returned to you

The T-cells are then sent to a special laboratory where they are genetically modified and turned into CAR T-cells that can destroy your cancer cells.

Bridging therapy

It can take several weeks to create your CAR T-cells. While you wait, your doctor may recommend that you have some chemotherapy or radiation to prevent your disease from getting worse. This is called bridging therapy. Some patients are hospitalized for this treatment while others can receive it in the outpatient clinic.

What happens when the CAR T-cells are infused into the patient?

A few days before you scheduled to receive your CAR T-cells, you will be given chemotherapy to prepare your body to receive the CAR T-cells. This process is called lymphodepletion and may cause:

  • fatigue
  • low blood counts
  • nausea

The infusion of CAR T-cells will take place in the hospital or in the outpatient clinic, where you will be carefully monitored. You will be awake during the infusion. Your CAR T-cells will be returned to you much like a blood transfusion.

Depending on which CAR T-cell product you are receiving and whether complications or side effects develop after the infusion, you may need to be in the hospital for several days or weeks.

Next: Side Effects of CAR T-cell Therapy

Updated September, 2023