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Starting CAR T for Follicular Lymphoma

Reviewed by Laura J. Martin, MD on March 10, 2021

CAR T-cell therapy is a cancer treatment that works by helping your immune system do its job better. It’s currently offered only once you’ve tried at least two other chemotherapies that didn’t work. To be sure you’re a good candidate for it, your doctor will review your medical records, do screening tests, and study images and biopsy results you’ve had in the past. Once you’re cleared to go ahead, here’s what the process will look like.

Cell collection

First, your doctor will need to collect some of your white blood cells (T cells) in a process called leukapheresis. You sit in a reclining position or lie down while a technician connects you to two IVs. One IV draws your blood. The blood goes through a machine that separates your T cells from the blood sample. Then it sends that blood back into your bloodstream through the second IV.

You’ll need to stay still in one place for 2-3 hours while this happens. You may feel numb, tingly, or have muscle spasms during the process if your calcium levels drop. Your health care team can give you calcium to help manage these symptoms.

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You might have this collection done during your consultation visit with your doctor, or you may come back for a separate appointment after your first visit to do it. Your T-cell sample then goes to a lab.

CAR T-cell prep

Once your T cells are in the lab, technicians genetically engineer them, or change their genetic makeup.  They add certain protein receptors -- chimeric antigen receptors -- to their surface. Now your T cells are CAR T cells.

These CAR T cells grow and multiply in the lab for 2-3 weeks until there are millions of them. Then the lab freezes them and sends them back to the facility where you’ll receive your treatment.

Getting your body ready

A few days before you have your CAR T-cell infusion, your doctor may give you light chemotherapy. This helps lower the number of immune cells in your blood, which boosts the effect the CAR T cells can have on your cancer cells. This is called conditioning therapy.

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Treatment infusion

You’ll be admitted to the hospital to get your CAR T-cell infusion. A technician puts the CAR T cells back into your bloodstream using the same process as a typical blood infusion. The process normally takes 30-90 minutes. After it’s finished, you’ll stay in the hospital for at least several hours and possibly several days afterward so your medical team can watch you.

CAR T-cell therapy is a one-time infusion.

Recovery

You need to plan for a caregiver to be with you 24 hours a day after your infusion while you’re recovering. Your doctor will ask you to stay close to the hospital (within a 2-hour drive) for at least a month after your treatment in case you have complications and for care check-ins. You won’t be able to drive during your recovery time.

You’ll have frequent visits to your clinic during the 2-3 weeks after your infusion. This helps prevent serious reactions to your treatment such as high fevers, trouble breathing, or drops in blood pressure. It’s typical to feel tired and to not feel hungry during this early recovery time.

You may be admitted to the hospital again during your recovery time if you have health issues related to treatment.

WebMD Medical Reference

Sources

SOURCES:

Dana-Farber Cancer Institute: “Frequently Asked Questions About CAR T-Cell Therapy,” “What is CAR T-Cell Therapy and How Does It Work?”

Mayo Clinic: CAR-T Cell Therapy Program.”

American Cancer Society: “CAR T-cell Therapy and Its Side Effects.”

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