Chimeric antigen receptor T-cell therapy, or CAR T-cell therapy, is an innovative and promising treatment approach that has revolutionized the field of cancer therapy.

Nebraska Medicine was one of the first health networks in the Midwest to offer CAR T-cell therapy for people with relapsed B-cell non-Hodgkin lymphomas and pediatric/young adult acute lymphoblastic leukemia. In the last several years, CAR T-cell therapy has been approved for even more types of blood cancers.

Understanding CAR T-cell therapy

T-cells, a type of white blood cell, play a crucial role in the body's defense against infections and diseases. They are responsible for identifying and eliminating abnormal cells, including cancer cells.

However, cancer cells often develop mechanisms to evade detection and destruction by the immune system, leading to uncontrolled growth and spread of the disease, explains Julie Vose, MD, MBA, chief of Hematology-Oncology.

“These patients’ immune systems, or lymphocytes, do not see their cancer as being foreign and do not fight it,” Dr. Vose says. “With CAR T-cell therapy, we take the patient’s cells out of their blood and work with a pharmaceutical company that genetically engineers the cells and teaches them to notify the patient’s immune system that their cancer is a foreign substance and help to fight it.”

What is CAR T-cell therapy used for?

CAR T-cell therapy has shown success in the treatment of certain types of blood cancers, mainly some kinds of lymphomas and leukemias. It is approved by the U.S. Food and Drug Administration to treat the following:

• B-cell precursor acute lymphoblastic leukemia in children and young adults up to age 25
• Diffuse large B-cell lymphoma
• Primary mediastinal large B-cell lymphoma
• Large B-cell lymphoma transformed from follicular lymphoma
• High-grade B-cell lymphoma
• Aggressive B-cell lymphoma not otherwise specified
• Follicular lymphoma
• Mantle cell lymphoma
• Multiple myeloma

CAR T-cell therapy is being studied in clinical trials for additional types of cancers, including solid tumors, like breast or lung cancers. As research and development continues, CAR T-cell therapy holds great potential for improving patient outcomes in the future.

Overview of the Nebraska Medicine process

The entire CAR T-cell therapy process may take several months. Patients can expect the following:

1. Their T cells are collected and sent to a lab for processing during the first phase.
2. The patient returns home for approximately three to six weeks while these cells are in production.
3. Once the cell modification is complete, the patient returns to the Nebraska Medical Center and receives a few days of chemotherapy to prepare their body to receive the cells.
4. The patient then has their own modified T cells placed back into their bloodstream. A specialized team monitors them at the hospital for the next two weeks to watch for side effects of the treatment.
5. The patient continues to be monitored closely as an outpatient for the next few weeks.

How much does CAR T-cell therapy cost?

CAR T-cell is the first genetically altered cellular therapy to reach a commercial product. Given this is a new treatment, Nebraska Medicine patients are assigned a financial counselor to work with them and their insurance company regarding coverage options.