Nine Facts About CAR T-Cell Therapy for Multiple Myeloma
Living with multiple myeloma may mean navigating a variety of treatment options. One potential treatment that your oncologist may suggest is CAR T-cell therapy. But what is this treatment, and what does it entail?
Click through the following slideshow to find out nine facts about CAR-T cell therapy, how it works, and the mechanism it uses to help treat multiple myeloma.
It’s a Type of Immunotherapy
Immunotherapy is a form of cancer treatment that allows your own body to seek and destroy cancer cells, and CAR T-cell therapy is one way to do that.
“Chimeric Antigen Receptor T-cell (CAR T) therapy is a type of immunotherapy that uses genetically modified T cells to recognize and attack cancer cells,” said Wael Harb, MD, board-certified hematologist and medical oncologist at MemorialCare Cancer Institute at Orange Coast and Saddleback Medical Centers in Orange County, California.
It’s Used for Refractory or Relapsed Myeloma
CAR T-cell therapy is an effective treatment, but it’s not for everyone. “It’s reserved for relapsed or refractory multiple myeloma, where other treatments, including stem cell transplant, have failed,” Dr. Harb said.
There are currently two FDA-approved CAR T-cell therapies for multiple myeloma:
- Idecabtagene vicleucel (Abecma), also called ide-cel, and
- Ciltacabtagene autoleucel (Carvykti), also called cilta-cel.
Both target a protein called B-cell maturation antigen (BCMA) on the myeloma cells.
It’s Not an “Off the Shelf” Treatment
Unlike some treatments, where the patient can start the same day the oncologist recommends it, CAR T-cell therapy typically has a waiting period before you can start it, said Manni Mohyuddin, MD, assistant professor at Huntsman Cancer Institute. This is because CAR T is made from the patient’s own cells.
“If I intend to give somebody CAR T today, it’s probably going to take [several weeks] before I can actually give it, and this is because it takes time,” he said. The entire process usually takes two to eight weeks, followed by a few weeks of monitoring.
CAR T-Cell Therapy is a Multi-Step Process
During the CAR T-cell therapy process, the provider collects a sample of T cells from your blood in a process called leukapheresis. The T cells are then genetically altered in a lab to express a chimeric antigen receptor based on your cancer type.
While the lab is creating an adequate supply of these T cells, you’ll receive bridging therapy as well as a round of chemotherapy to kill your existing T cells, which prepares your body for the new, altered T cells. The new T cells are then infused into your body intravenously.
Side Effects May Occur
After the T cells are infused back into your body, you may experience some side effects. Some people get cytokine release syndrome, typically within two weeks after the infusion, Dr. Mohyddin said.
“This basically means that you can get a fever and some inflammation, which is a direct result of those [activated] immune cells that we've given. Usually, it’s mild, but it can be severe.” Other patients may temporarily get confused because of immune cells entering the spinal cord or brain.
After CAR T-Cell Therapy, You’ll Discontinue Myeloma Treatment
After your CAR T-cell therapy process is complete and you’re no longer experiencing side effects, you’ll continue being monitored by your care team. However, you will stop your multiple myeloma treatment unless your cancer returns, which could take months or even years, Dr. Mohyuddin said.
“So you get a prolonged treatment break, and that is associated with a better quality of life, and patients love being off treatment,” Dr. Mohyuddin added.
Most Myeloma Patients Respond to CAR T
Most multiple myeloma patients who receive CAR T-cell therapy respond to it. “The response rate of anti-BCMA CAR T-cell therapy is around 80%-90%,” said Abhinav Deol, MD, a hematologist and medical oncologist and member of the Bone Marrow and Stem Cell Transplant Multidisciplinary Team at Barbara Ann Karmanos Cancer Institute.
Among relapsed-refractory multiple myeloma patients, the average progression-free survival period was 8.63 months, and average duration of response was 14.48 months but it can be significantly longer depending on the product used.
If CAR T Fails, Myeloma Treatment Will Be Updated
If you don’t respond to CAR T-cell therapy treatment or your myeloma progresses after receiving it, your care team will recommend a different treatment regimen to control your disease, said Michelle Armstrong, APRN, NP-C, a bone marrow transplant nurse practitioner at Methodist Le Bonheur Healthcare in Memphis, Tennessee.
“This is often based on treatment received in the past as well as treatment tolerance and patient co-morbidities,” she added.
Your Care Team Can Help You Navigate CAR T Coverage Details
Because CAR T-cell therapy is relatively new, not all insurance companies have published policies on whether it’s covered for multiple myeloma.
Work closely with your care team to navigate the financial side of this treatment. Their billing team can develop an estimate of what your out-of-pocket expenses may be based on their conversations with your insurer.