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CAR-T

Understanding CAR-T

Immunotherapy, or more specifically cancer immunotherapy, is a type of treatment that helps the body’s immune system fight cancer. The body’s immune system fights infections and disease. It is made up of white blood cells, and the organs and tissues of the lymphatic system. T cells are a type of white blood cell.

Chimeric Antigen Receptor T cell therapy, or CAR-T therapy, is a type of immunotherapy that modifies a patient’s T cells to better detect and destroy lymphoma.

CAR-T therapy uses the T cells from the patient’s blood. The T cells are isolated and sent to a special laboratory where they are genetically modified with inactive viruses with a receptor that detect proteins on the surface of a tumour cell. The modified cells, called CAR-Ts, are sent back to the patient’s treatment centre and infused back into the patient. Once in the patient’s body, the CAR-Ts target the cancer cells and the cancer cells are destroyed by the body’s immune system.

Generally speaking, the following patients are eligible for CAR-T therapy:

  • Diagnosed with a subtype of lymphoma for which the CAR-T therapy is approved
  • Meet regulatory criteria (e.g. relapsed twice and have been previously treated)
  • Have tumours that express the specific antigen the therapy targets
  • Have normal or limited performance status
  • No active infections
  • No significant cardiac, neurological or immune dysfunction

However, in addition to subtype and stage, physicians will also assess the patient’s overall health, fitness and circumstance for this treatment. This may include the patient’s comorbidities, the associated ability to withstand the vigorous treatment, and their willingness and ability to travel for treatment.

🎥 Video Series: Insights into CAR-T Therapy

CAR-T in Clinical Practice – Prof. John Gribben at the Global Summit 2024

Presented during the Lymphoma Coalition Global Summit 2024, these three short video clips feature Prof. John Gribben (UK) – Leading lymphoma clinician-scientist, and former EHA President —discussing key clinical aspects of CAR-T therapy in the treatment of relapsed or refractory diffuse large B-cell lymphoma (DLBCL).

The series offers an accessible breakdown of the latest evidence, including the impact of trials such as Zuma-7, real-world data, and ongoing discussions around where CAR-T fits within the treatment algorithm, especially in comparison to bispecific antibodies.

CAR-T & The Patient Experience – Interview with Jonathan, Patient Advocate

This four-part video interview features Jonathan Clark, who underwent CAR-T therapy and shares his personal reflections in a series of short, focused clips. The goal is to provide insight for others going through similar journeys—offering practical advice, emotional perspective, and lessons learned.

Whether you’re preparing for CAR-T, supporting a loved one, or advocating for patient-centred care, Jonathan’s testimony brings a valuable voice to the conversation.

Research Spotlight: LC Abstract at the EHA 7th Annual CAR-T Meeting

This recorded presentation highlights a research abstract accepted at the EHA 7th Annual CAR-T Meeting, presented by Natacha Bolaños, Head of Membership & Alliances at Lymphoma Coalition. The study focuses on patient perspectives and challenges in the CAR-T care pathway, emphasising the importance of integrating patient voices into clinical and policy discussions.

This work reflects LC’s ongoing commitment to evidence-based advocacy and to improving access and equity in CAR-T therapy worldwide.

CAR-T Protocol

Patients consult with their physician to see if they are medically eligible for CAR-T therapy. This may include submitting medical records to the specialty laboratory that manufactures the CAR-Ts.

Blood is taken from the patient and the white blood cells that contain T cells are isolated and removed in a process called apheresis or leukapheresis. The remaining blood is transfused back to the patient.

TIMELINE: The procedure takes 3-6 hours

The T cells are shipped to a designated laboratory where they are genetically modified with inactive viruses into CAR-Ts and expanded. The modified cells are shipped back to the patient’s treatment centre.

TIMELINE: Approximately 2-4 weeks

Patients may be given low-dose chemotherapy called lymphodepleting chemotherapy to reduce their number of immune cells before the CAR-Ts are infused. This helps the CAR-Ts start to grow and multiply within the patient. The patient may receive a bridging therapy to help keep their cancer in check while waiting for CAR-T therapy.

TIMELINE: Approximately 2-14 days before the CAR-T infusion

The modified CAR-T cells are infused into the patient at their treatment centre.

TIMELINE: 30-60 minutes

Patients are monitored regularly to see if the CAR-T therapy is effective and for short- and long-term side effects. Patients are advised to stay near their treatment centre for a few weeks. Most short-term side effects can be managed with supportive therapies. These include infections and haematological-related issues, such as prolonged or febrile neutropenia, anaemia and thrombocytopenia. Other more serious and potentially life-threatening side effects include cytokine release syndrome (CRS) and neurotoxicity (now termed IEC-associated neurotoxicity syndrome or ICANS). It is important patients and carers can identify symptoms quickly so they can be treated. The treatment centre will have instructions about what to do and who to contact if symptoms develop.

TIMELINE: Ongoing


Side Effects

There are several short- and long-term side effects related to CAR-T therapy. Patients are advised to stay near their treatment centre for a few weeks. Most short-term side effects can be managed with supportive therapies. However other side effects can be more serious and potentially life-threatening and may require treatment in a hospital intensive care unit.

Severe side effects are often the results of the high activity of the immune system brought on by the CAR-T therapy. Immunosuppressive drugs and corticosteroids are used in symptom management, with the goal of curtailing the side effects without removing the CAR-T cells completely. It is important patients and carers can identify symptoms quickly so they can be treated appropriately, especially since the symptoms of some side effects (like neurotoxicity) are the same as those of other medical conditions which are treated very differently.

As CAR-T cells are released and multiply in the patient’s body, their immune system is highly activated and releases a massive number of inflammatory cytokines into the blood, causing cytokine release syndrome (CSR). This can happen within the first week after infusion or later in some cases. The duration and intensity of CSR can vary. Some patients only experience mild flu-like symptoms while others have high fevers, hypoxia (oxygen deficiency), low blood pressure and multi-organ toxicity.

IEC refers to Immune Effector Cells. The CAR-T cells can have an effect on the patient’s brain, which can cause confusion, agitation and a lack of awareness. Patients may experience headaches, difficulties with written or spoken language, anxiety and occasional seizures. Neurotoxicity can occur with or without cytokine release syndrome. If a patient also experiences CRS, neurologic symptoms more commonly occur after CRS. It is reversible in most cases, but in rare cases, cerebral oedema associated with neurotoxicity may develop, which is potentially fatal.

Macrophage-activation syndrome is the severe inflammation of the immune system, which can cause multi-organ failure.

Febrile neutropenia is an abnormal decrease in the number of certain white blood cells in the blood coupled with fever.

B cell aplasia is a low number of B cells or no B cells. This is a common lasting side effect of CAR-T.

Anaemia is a condition in which the number of red blood cells is below normal.

Thrombocytopenia is a decrease in the number of platelets in the blood.

Hypogammaglobulinemia is a reduction in all types of gamma globulins, including antibodies that help fight infection.

Watch Erik Aerts, a nurse at the Klinik für Hämatologie, University of Zurich and President of the Haematology Nurses & Healthcare Allied Professionals Group (HNHCP) speak about CAR-T side effects.