CAR T-Cell Therapy for Multiple Myeloma

Researchers are finding new ways to fight multiple myeloma, including a new treatment called CAR T-cell therapy. It's still experimental, but you may get a chance to join a clinical trial if your other treatments aren't working.

CAR T-cell therapy works differently from other cancer treatments. It trains your immune system to find and kill cancer. And it's tailor-made for you.

What Happens in CAR T-Cell Therapy?

First, doctors collect immune cells called T cells from your blood. These cells are genetically engineered to make a chimeric antigen receptor (CAR). CARs seek proteins on the surface of cancer cells and attach to them.

Technicians multiply these engineered immune cells in a lab until there are millions of them. Your doctor puts them back into your body through an IV, where they seek out and kill cancer cells. CAR T cells can stay alive in your body and keep attacking cancer cells for many years.

CAR T-cell treatments for multiple myeloma target a protein called B-cell maturation antigen (BCMA). BCMA is on the surface of myeloma cells but not healthy cells.

How Well Does It Work?

Clinical trials for multiple myeloma so far have been small, but promising. One One U.S. study of a CAR T-cell therapy included 21 people who had already tried an average of seven other treatments. Eighteen of them got a higher dose of the treatment. About 56% of those 18 people had complete remissions, meaning there was no longer any sign of their cancer.

A Chinese study included 35 people with multiple myeloma. About 94% showed signs of remission after CAR T-cell therapy.

These two studies are the earliest types of clinical trials, called phase I, which are done to check the treatment's safety, not how well it works. More studies that are longer and have larger groups of people are needed to show this treatment works for multiple myeloma and how long people live who get it.

Right now there are more than 20 clinical trials in various stages across the U.S. To learn more about them, visit the U.S. National Library of Medicine’s Clinical Trials.gov site.

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Side Effects and Risks

One of the most common side effects from CAR T-cell therapy is called cytokine release syndrome (CRS). It's an immune response that's triggered by a flood of immune system chemicals called cytokines into your body.

CRS causes symptoms like:

These symptoms usually start within a few days after your treatment and get better over time.

Most of the people in CAR T-cell studies for multiple myeloma got CRS, but their symptoms were mild. Doctors can quiet the immune system response and treat CRS with the drug tocilizumab (Actemra).

CAR T-cell therapy can also cause side effects like:

People who've been treated with CAR T-cell therapy for multiple myeloma have not had these side effects.

If you have CAR T-cell therapy, your doctor will monitor you for about 2 to 3 months afterward while you recover. You'll be checked often for side effects and to see if the treatment is helping.

How to Talk to Your Doctor About CAR T-Cell Therapy

Ask your doctor if you qualify for a CAR T-cell therapy trial. Usually you'll need to have tried several other multiple myeloma treatments first.

Before you join a clinical trial, ask the study doctor:

  • What is the purpose of this trial?
  • How might this treatment help me?
  • How long will the trial last?
  • What kinds of tests and treatments are involved?
  • What are the possible side effects?
  • How do the risks and benefits compare to other multiple myeloma treatments?
  • Will I have to pay any of the costs for tests, treatments, or for travel to the trial site?

Your doctor can tell you how to join a clinical trial for CAR T-cell therapy for multiple myeloma. 

WebMD Medical Reference Reviewed by Louise Chang, MD on May 17, 2018

Sources

SOURCES:

American Society of Clinical Oncologists: "ASH 2017: Clinical Activity Seen with Anti-BCMA Car T-Cell Therapy in Heavily Pretreated Multiple Myeloma."

Cancer.Net: "Multiple Myeloma: Treatment Options."

Cancer Support Community: "CAR T Cell Immunotherapy."

Clinical Journal of Oncology Nursing: "Cytokine-release syndrome."

Dana-Farber Cancer Institute: "Frequently Asked Questions About CAR T-Cell Therapy," "What Are The Side Effects of CAR T-Cell Therapy?"

MyelomaCrowd: "ASCO 2017: CAR T Cell Therapy Shows Incredible Results in Myeloma," "CAR T-Cell Therapy: 9 Things to Know."

National Cancer Institute: "CAR T Cells: Expanding Into Multiple Myeloma," "Questions to Ask Your Doctor About Treatment Clinical Trials," "With FDA Approval for Advanced Lymphoma, Second CAR T-Cell Therapy Moves to the Clinic."

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