How Does CAR T-Cell Immunotherapy Work?

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Topics include: Treatment and Understanding

For several years, researchers have been excited about CAR T-cell immunotherapy as a potential CLL treatment.  But what is it? Dr. David Maloney, a leading CLL researcher from Seattle Cancer Care Alliance, explains the process of CAR T-cell immunotherapy and how it could work to treat CLL. 

This program was sponsored by The Patient Empowerment Network, which received educational grants from AbbVie, Inc., Genentech and Gilead Sciences, Inc.

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Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you.

Okay. We're going to have time for questions. There's a whole like hour at the end of the day. So be noting your questions. Well, let's go on to where research is headed, because some of these things just recently came out of research. So this is, there's a whole list.

So, Dr. Maloney, you're often involved in this stuff, and often an investigator, as is Dr. Pagel. So what's going on here in the lab?

Dr. Maloney:

Well, I'm looking at the top on the list there, so CAR T cells, and that's one of my big interests right now, so I'll just say a few seconds about that. This is kind of a, one of the hottest things in the country right now for the treatment of lymphoma or leukemia, and the idea is can we retrain you own T cells to attack your disease?

And so, the idea is we take out your T lymphocytes, as Dr. Pagel said. Those T-lymphocytes are cells that can help fight infection or attack things. But they're usually not very effective at getting rid of your CLL on their own.

And so we can trick them by taking them and collecting them from your blood. The process is called leukopheresis, and it requires taking blood out of one arm and running through this machine, like a dialysis machine.

We take out the small fraction of cells that are the T cells, or containment T cells, give you the rest of your blood back in the other arm. And you have to sit there for about three hours to get those T cells collected.

But then we take those T cells and we infect them with a virus, and the virus is carrying DNA that makes those cells, if they get infected with that virus, then makes those cells make that receptor. Now that receptor tricks the cells into attacking your B cells, and the way it does it is essentially that receptor is kind of like an antibody.

It’s like a, it’s like rituximab only it’s directed against the target called CD19. So this little kind of fake receptor, that we trick the T cells into making, makes them now attack your B cells.

So those cells can be then grown in the laboratory. It takes about a month to grow them up to several million, or hundred million copies of these cells. And then they can be given back as an injection, usually after a round of some kind of chemotherapy.

Now those cells, as soon as they kind of hit you, they start looking for the CLL cells, if we’re lucky, and they can then proliferate, because they can actually grow. They get signaled by the CLL cells and, if we’re lucky, then they grow and they can actually kill those CLL cells.

So we’ve just started this about a year ago and other centers are doing this. You’ve heard, I’ve read about it in The Wall Street Journal and New York Times. The Penn Group, NIH group, a lot of groups are doing it and it’s very exciting.

We have very little experience so far in CLL, but that’s one of the diseases where this seems to work pretty well and everyone’s very excited about it. Now it’s not for everybody. In fact, it’s probably not for many people because it is still an aggressive therapy.

When these T cells kind of start revving up and going after the leukemia they can get really excited and that can, and that can make people really, really sick. In fact, even people can die from the complications of these T cells killing off their leukemia cells, like overnight. I mean, they can really, they can really, really get activated.

So part of the trick here is learning how to do this safely in people so that the T cells start off slow enough that they don’t cause too much havoc along the way. And people feel kind of like they have the flu, the worst flu of your life, with, you know, high fevers and can be very, very, very sick.

So it’s not for everybody, but it may be in the future that we’ll just take a tube of blood or two out of your arm and make these T cells and have you come back in and get a combination of T cells against your cancer or your leukemia, and they get rid of it. Now that’s the future, okay? That’s not the present.

Right now we’re in the earliest phases of these studies, but it’s really, really exciting. So if people get to the point where these standard things aren’t working, then those are the times to start thinking about these experimental clinical trials.

But, you know, there’s really no reason to start thinking about that kind of an approach if you’ve got all these other things on the table that are clearly safer than doing CAR T cells.

Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you.

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Page last updated on July 19, 2017