If you have relapsed or refractory multiple myeloma, you might be a good fit for CAR T-cell therapy. It’s a specialized treatment that involves genetically changing your immune cells and training them to kill the cancer. It has the potential to be very effective, but like most things, there are pros and cons.
Pro: It Could Buy You More Time
Relapsed or refractory multiple myeloma means your cancer has returned after initial treatment appeared to be successful, or the cancer isn’t responding to standard treatment.
CAR T-cell therapy is a type of immunotherapy, a treatment that taps the power of your own immune system. T cells, also called T lymphocytes, are part of your immune system. They make antibodies that fight invaders and can kill infected cells. With CAR T-cell therapy, your T cells are removed from your body, and genetic information is added. This prompts the cells (which are later put back in your body) to make chimeric antigen receptors (CARs). Those are proteins that help T cells target cancer cells.
Individual response depends on the person, but CAR T-cell therapy can be very effective. With conventional treatments, only about 30% of people with relapsed or refractory multiple myeloma see a response. Most survive for about a year.
With idecabtagene vicleucel, the first CAR T-cell therapy to be approved for myeloma, about 80% of people with relapsed or refractory multiple myeloma see a response. The average survival time is about 1.5 years. With ciltacabtagene autoleucel, another approved CAR T-cell therapy for myeloma, the odds may be even better: Research shows 98% see a response and 60% are “free of disease progression” at the 2-year mark. That means the cancer is not growing or spreading.
Of course, CAR T-cell therapy doesn’t work for everyone, and there are several possible downsides to consider.
Con: Treatment and Recovery Take Several Months
CAR T-cell therapy has several steps. You’ll get your blood drawn so the T cells can be taken out and genetically changed in a lab. The process takes about 6 weeks. During this time, you’ll get what’s known as bridging therapy. That’s a temporary treatment to help to keep your cancer controlled.
Next, you’ll do a short course of chemotherapy to kill off some remaining immune cells, known as lymphodepletion. This improves the chances CAR T-cell therapy will work. When your body is prepped and the CAR T-cell product is ready, you’ll get infusions of it. You’ll be in the hospital for at least a week while this is happening.
Your healthcare tea will watch you closely for 2-3 months once you’re finished. That’s because people who get CAR T-cell therapy often need to be readmitted to the hospital because of complications. At the very least, you’ll need to stay near the treatment center, which might mean temporarily relocating.
Con: It May Lead to Serious Side Effects
CAR T-cell therapy can cause problems that are serious and even life-threatening. The good news is these complications can be treated and reversed most of the time. One of the most common serious side effects is cytokine release syndrome, an overreaction of the immune system. It can cause:
- Fever
- Low blood pressure
- Muscle pain
- Organ failure (severe cases)
It’s also possible to have a neurological reaction, also called neurotoxicity. If this happens, you may:
- Become confused
- Have seizures
- Have difficulty speaking or walking
CAR T-cell therapy also raises your risk of infections. Because of this, your white blood count will be checked often. And you’ll need to keep an eye out for signs like fever.
Lastly, because CAR T-cell therapy is relatively new, researchers don’t yet know what the long-term side effects might be.
Con: Access Can Be Tricky
Because CAR T-cell therapy is relatively new and complex, it’s only done at specialized medical centers. You may need to travel to get treatment. Your doctor can give you suggestions. You can also search the Blood & Marrow Transplant Information Network’s directory.
Cost is another concern. Medicare covers CAR T-cell therapy, and many (but not all) commercial health insurers do, too. But that doesn’t mean the entire cost will be taken care of. Coverage depends on the state and your insurance plan, so you may still be left with a sizeable bill. The list price of a CAR T-cell infusion is as much as $475,000. That’s not including inpatient hospital care and monitoring after the procedure.
Show Sources
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SOURCES:
Blood and Lymphatic Cancer: “CAR T-Cell Therapy for Patients with Multiple Myeloma: Current Evidence and Challenges.”
Blood & Marrow Transplant Information Network (BMT InfoNet): “Financial Considerations for CAR T-cell Therapy Patients.”
British Journal of Haematology: “How I Treat Triple-Class Refractory Multiple Myeloma.”
Cleveland Clinic: “CAR T-Cell Therapy.”
Dana-Farber Cancer Institute: “CAR T-Cell Therapy for Multiple Myeloma,” “Exploring How CAR T-Cell Therapy May Help More Patients,” “Frequently Asked Questions About CAR T-Cell Therapy.”
International Journal of Environmental Research and Public Health: “Price and Prejudice? The Value of Chimeric Antigen Receptor (CAR) T-Cell Therapy.”
Journal of Clinical Oncology: “Ciltacabtagene Autoleucel, an Anti-B-cell Maturation Antigen Chimeric Antigen Receptor T-cell Therapy, for Relapsed/Refractory Multiple Myeloma: CARTITUDE-12-Year Follow-Up.”
The Lancet Haematology: “Access to and Affordability of CAR T-Cell Therapy in Multiple Myeloma: An EBMT Position Paper.”
Leukemia & Lymphoma Society: “Chimeric Antigen Receptor (CAR) T-Cell Therapy,” “FDA Approves Novel CAR T-Immunotherapy for the Treatment of Multiple Myeloma,” “Myeloma/Refractory and Relapsed.”
Mayo Clinic: “Understanding CAR-T Cell Therapy and Its Potential Side Effects.”
Moffit Cancer Center: “Does Intensifying Lymphodepletion Impact CAR T-Cell Therapy?”
New England Journal of Medicine: “Idecabtagene Vicleucel in Relapsed and Refractory Multiple Myeloma.”
