What are the treatment process and toxic side effects of CAR-T immunotherapy?

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What are the treatment process and toxic side effects of CAR-T immunotherapy?

CAR-T immunotherapy has attracted much attention in recent years. What is its treatment process? What should the patients do if there are side effects during the treatment?

What is the complete treatment process of CAR-T immunotherapy?

The CAR-T immunotherapy process is different from traditional drugs because it is an individualized treatment method.

If a patient wants to undergo car-t cell therapy, we must first assess whether this patient is suitable for car-t cell therapy.

For example, whether his pathological diagnosis, physical condition meets the treatment conditions, and whether the previous treatment is adequate.

If the patient comes and says: “I have just been diagnosed with lymphoma, and I need CAR-T immunotherapy.” In this case, it cannot be done because the patient has not received treatment in the past, and the current car-T cell The approved indication for treatment is relapsed and refractory large B-cell lymphoma.

In addition, if the patient’s physical condition is particularly poor and cannot tolerate the toxic and side effects that may occur during the treatment, the doctor will advise the patient after the evaluation, the risk is too high and the CAR-T immunotherapy may not be possible.

Evaluation and inspection:

After the assessment, if the patient meets the conditions for car-t cell therapy, we will perform a comprehensive examination on the patient.

Collect T cells:

After the examination is completed, the patient’s T cells are collected. Use the machine to filter the patient’s blood, leaving only the T cells we need.

Modify T-CELL:

Take T cells to LAB for transformation, which can be completed in about 3-4 weeks.

Bridging chemotherapy:

During the transformation of T cells, if the patient’s tumor grows faster, he can receive other treatments first, such as chemotherapy, targeted therapy, radiotherapy, etc., to control the tumor first.

This is called bridging chemotherapy, in order to prevent the patient’s condition from getting worse and affecting the subsequent car-t cell reinfusion. Before reinfusing car-t cells, a chemotherapy is required to remove normal lymphocytes in the body.

The imported car-t cells are a kind of lymphocytes, which need to be amplified after being infused into the body. Only after the expansion can they effectively damage the tumor cells and achieve the desired therapeutic effect. However, if there are a lot of normal lymphocytes in the body, the space in the body is limited, and the car-t cells cannot be expanded.

Reinfusion of car-t cells:

There are three key points after reinfusion of car-t cells:

Whether car-t cells can expand,
Whether car-t cells are effective,
Toxic side effects.

The first month after reinfusion of car-t cells is the most critical. During this period, we need to monitor the patient’s toxic and side effects, such as cytokine release syndrome and neurotoxicity.

Cytokine release syndrome includes fever, hypotension, hypoxemia and so on.

If the patient has a toxic side effect, the doctor will use some drugs for treatment, and the very serious patient must be transferred to the intensive care unit for more active monitoring and rescue methods.

Hospitalized for observation:

If the patient does not have these side effects within one week of the car-t cell reinfusion, the probability of subsequent side effects will be relatively small.

Therefore, doctors generally recommend that patients be hospitalized for observation within a week after the reinfusion.

If there is no toxic side effect, the patient can be discharged from the hospital without any major problems after that week, and imaging examination will be performed one month later to evaluate the efficacy.

The patient has no toxic side effects within a week after the car-t cell reinfusion. It is also recommended to live near the hospital after discharge, because toxic side effects may still occur within a month. In case of side effects, the patient should promptly Return to the hospital for treatment.

Do these patients need to undergo regular return visits after chemotherapy, like other cancer patients?

If necessary, it is generally recommended that the patient undergo a re-examination within 2-3 months after confirming that the treatment is effective and discharged from the hospital.