Almost all people with multiple myelomarelapse or get refractory myeloma. That means their cancer returns or isn’t responding to treatment.
But there are options in these situations. One of the most promising is CAR T-cell therapy. Here’s what you need to know.
What Is CAR T-Cell Therapy?
CAR T-cell therapy uses your own cells to fight the disease. Scientists take T cells -- a type of immune system cell -- from your blood and change them in a lab. A gene for a special receptor that sticks to cancer cells is added. This receptor is known as a chimeric antigen receptor (CAR).
That turns them into CAR T-cells that attack myeloma cells. Millions are grown in a lab, then put in your body a few weeks later.
How Well Does CAR T-Cell Therapy Work?
There are two drugs approved for CAR T-cell therapy for multiple myeloma: ciltacabtagene autoleucel and idecabtagene vicleucel. There’s not a lot of long-term research because they haven’t been on the market for long. But what’s been reported so far is promising.
One study found that the overall response rate for people on idecabtagene vicleucel was 71%, compared to 41% on standard therapy. The overall response rate to treatment includes the number of people whose tumors got smaller (partial response) or who no longer have signs of cancer (complete response).
More than 40% of people on idecabtagene vicleucel had a complete response, too, compared to just 5% of those on standard therapy. After 2.5 years, people treated with idecabtagene vicleucel were also 51% less likely to see their disease worsen.
Another study found that almost 76% of people on ciltacabtagene autoleucel did not get worse after a year, compared to 48% of people who got standard care. A little more than 70% of people on ciltacabtagene autoleucel also had a complete response, compared to almost 22% in the standard care group.
Who Can Try CAR T-cell Therapy?
If you have multiple myeloma and you’re interested in trying CAR T-cell therapy, there are a few requirements:
You’ve relapsed or your condition has become refractory. That means the cancer has come back after you’ve tried at least four different treatments or it doesn’t respond to treatment.
You’ve already tried other treatments. These include a proteasome inhibitor, an immunomodulatory drug, and an anti-CD38 monoclonal antibody.
The good news is the rules for who can try for CAR T-cell therapy are less strict than other treatments like transplantation. That means people who are older or aren’t as healthy to begin with can get the procedure done.
What Should I Expect During CAR T-cell Therapy?
The whole process takes about 3 months from start to finish. Here’s a look at the steps:
Your doctor will make sure you’re a good fit. They’ll order certain tests and check other things to make sure your body can handle it. This can take about a week. These may include:
- Blood counts
- Tests for infection
- Pulmonary function test to check lung health
- Echocardiogram to check your heart health
- Blood test to check kidney and liver function
The treatment is approved by insurance. That’s a process that can take anywhere from 10 days to a month. While you wait, you’ll either rest at home or get other treatments, like chemotherapy, to try to keep your multiple myeloma stable.
Your T cells are collected. You’ll have to go to the hospital to get some white blood cells removed. You’ll lie in bed or sit in a reclining chair. Your medical providers will connect you to two IV lines. One removes blood to separate the white blood cells, and the other one puts the blood back into your body. It takes 2 to 3 hours. You’ll be monitored closely to make sure your blood calcium levels don’t go down. If they do, you’ll be given calcium supplements or infusions.
CAR T cells are created. Once the T cells are taken from your white blood cells, they’re sent to the lab. The gene for the specific chimeric antigen receptor (CAR) is added. The cells then grow and multiply in the lab. Once there are enough, they’re returned to the hospital. This step takes about 3 weeks.
You’ll do chemotherapy. They may give you chemotherapy a few days before the CAR T-cell infusion because it temporarily weakens your immune system. This gives the CAR T cells a better chance to activate and fight your myeloma. The chemotherapy won’t be too strong because CAR T-cell therapy works best when there are still some multiple myeloma cells present.
You’ll get the CAR T-cell infusion. When your cells are ready, you’ll return to the hospital and the cells will be put into your body through a central catheter. You may also be given medication at the same time to curb side effects and complications.
They’ll watch you closely for 30 days. Your doctor will let you know if you need to stay in the hospital or if you can leave. If you’re allowed to leave, you’ll have to stay nearby so you can come in to be checked every day. Staying no more than 15 to 20 minutes from the hospital is preferred in case emergency complications happen. After the 30 days are up, you’ll still need to return to the cancer center every 2 to 3 months after the checkup for about a year.
What Questions Should I Ask My Doctor?
Consider asking:
What are the risks? CAR T-cell therapy does have side effects that can be serious. These include cytokine release syndrome and a lowered immune system. You’re at higher risk of getting sick.
Is the timing right for me? To get this treatment, you need to have tried at least four other treatments already.
What are my other options? There may be different treatments that your doctor feels are a better fit for you or have fewer side effects.
Are there any CAR T-cell clinical trials available? There may be new CAR T-cell treatments in development that you can try, for example.
How expensive is it? You’ll want to know what your insurance will and will not cover.
Where do you recommend I get CAR T-cell therapy done? Some medical centers have more experience than others.
Show Sources
Photo Credit: SCIENCE PHOTO LIBRARY/Getty Images
SOURCES:
American Cancer Society: “CAR T-Cell Therapy and Its Side Effects.”
Blood: “Idecabtagene Vicleucel (ide-cel) Versus Standard (std) Regimens in Patients (pts) with Triple-Class-Exposed (TCE) Relapsed and Refractory Multiple Myeloma (RRMM): Updated Analysis from KarMMa-3.”
New England Journal of Medicine: “Cilta-Cel or Standard Care in Lenalidomide-Refractory Multiple Myeloma.”
MD Anderson Cancer Center: “Need CAR T-Cell Therapy? Here’s What to Expect.”
Dana-Farber Cancer Institute: “How CAR T-Cell Therapy Works.”
Bone & Marrow Transplant Information Network: “Steps Involved in CAR T-Cell Therapy.”
