How Can I Access CAR T Therapy? Follow These 5 Steps

5 Steps You Can Take to Access CAR T Therapy

If you’re a caregiver or patient with acute lymphoblastic leukemia (ALL), non-Hodgkin lymphoma (NHL), or multiple myeloma, you’ve likely heard of chimeric antigen receptor (CAR) T-cell therapy, more commonly referred to as CAR T therapy. However, finding access to this therapy can seem daunting.

CAR T-cell therapy involves the genetic manipulation and enhancement of a patient’s T cells in a laboratory, so the cells will effectively bind to and kill cancer cells. The manipulated cells are reintroduced to the patient through an intravenous infusion.

Because CAR T therapies are relatively new treatments, not every cancer center provides them. There are also several additional steps patients and caregivers need to know when considering CAR T as a treatment option.

Patient Power spoke with Muhamed Baljević, MD, FACP, Director of Plasma Cell Disorders Research and Vanderbilt Amyloidosis Programs (VAMP) at Vanderbilt University Medical Center, about how patients can access CAR T therapy, as well as important factors to consider.

1. Determine if you are eligible

The U.S. Food and Drug Administration (FDA) has approved CAR T therapy for the following types of cancer:

• Multiple myeloma

• B-cell precursor acute lymphoblastic leukemia

• Diffuse large B-cell lymphoma

• 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

• Mantle cell lymphoma

• Follicular lymphoma

Typically, CAR T therapy is an option if other forms of treatment, such as chemotherapy, have been unsuccessful. But eligibility differs depending on the specific type of cancer, so it’s best to start by asking your doctor if you are or may become eligible.

2. Start the conversation early

Early planning may facilitate a higher chance for you to receive CAR T therapy, because the process involves careful decision making, planning, and logistical preparation, Dr. Baljević said.

Timing may also be key, because the process of CAR T requires that you are healthy enough to undergo the procedure itself. This includes collecting T cells from your blood and sending them to a lab to create the genetically engineered T cells that will attack cancer cells – a process that can take up to several weeks.

Patients whose disease is progressing rapidly, and whose general health or ability to carry on ordinary daily activities is similarly declining, may have difficulty making it through all of the steps necessary to receive an infusion of autologous CAR T treatment.

“This is why early evaluation and referral to CAR T-cell specialists is important – so that plans can be made for the most optimal time and situation where CAR T-cell therapy can be received with greater success,” Dr. Baljević said.

3. Weigh the risks and benefits

Like other cancer treatments, CAR T therapy comes with its share of side effects and risks.

Some 70% to 90% of patients who receive CAR T therapy experience what is called cytokine release syndrome (CRS), which is an inflammatory response that causes flu-like symptoms, including high fever, drops in blood pressure, and difficulty breathing. These symptoms typically range from mild to severe and subside in a few days to a few weeks with appropriate treatment.

Your doctors will have to determine whether you can withstand toxicities associated with CAR T therapy.

4. Work with your doctor to get a referral, if needed

Not every cancer center offers CAR T therapy as an option, which requires a referral to medical facilities that perform the treatment.

Even if your local doctor is not affiliated with institutions that provide CAR T therapy, they can help refer you to an appropriate specialist who can then make plans and complete the necessary evaluations, Dr. Baljević said. Most centers who offer autologous and/or allogeneic stem cell transplantation also provide CAR T therapy.

5. Choose a center

If you are eligible for CAR T therapy, choosing a treatment center is an important step. After the treatment, you will need to remain within a close distance to the center for a few weeks after the therapy. This is so doctors can monitor and intervene if you experience any potentially serious side effects during your recovery.

Telehealth and virtual visits have also made meetings with specialty centers convenient, though in-person visits are important to adequately assess candidacy. Altogether, this allows you to speak with doctors about whether you qualify for CAR T therapy based on your disease and other factors. These visits can also inform you of other requirements for CAR T-cell therapy, Dr. Baljević said.