Exploring CAR-T Cell Therapy: A New Frontier in Cancer Treatment

What is CART 

CART is a form of Cellular therapy, which utilizes the immune system's power and targets the cancer cells. It is an exciting and new prospect for the treatment of cancer.

What type of CART is available 

Currently, only autologous CART is approved in India, for ages 15 years and above 

Principle of CART 

T cells are collected from the patient via apheresis, once an adequate dose is obtained it is sent to a lab where it is genetically engineered and a tumour-specific Chimeric antigen receptor (CAR) is added to T cells after which the cells are expanded. These modified T-cells: CARs are designed to recognize the specific proteins on the surface of cancer cells (antigens). Total time taken i.e. vein to vein time is approximately 20 days.

Patient before CART infusion is given 4 days of chemotherapy and after 48 hrs. post chemotherapy CART is infused. Approximate stay is for 20 days 

Indications for CART 

Relapsed / Refractory B Lymphoma – mantle cell lymphoma, follicular lymphoma & DLBCL.

Relapsed/Refractory B cell Acute Lymphoblastic Leukaemia, age 15 years and above.

CART brings in a ray of hope, especially for those cases who have either relapsed post-transplant or are unfit to undergo a Transplant.

Response rates 

After infusion these T cells destroy cancer cells, these engineered T-cells stay in the body and continue their surveillance, offering long-term immunity against specific cancers and reducing their chances of recurrence. The overall response rate ranges from 73% – 50%.

Complications 

Patients can have cytokine release syndrome, cytopenia, fever, thrombocytopenia and HLH, these symptoms have to be treated very stringently in an experienced setup. At Fortis Hospital Shalimar Bagh, Delhi we are actively working in the field of CART and hence have vast experience in handling complications associated with CART therapy. 

Future directions 

Active investigations and trials are underway for multiple myeloma, other blood malignancies and solid malignancy.

For more information and formal discussion consult Dr. Akash Khandelwal Consultant and Unit Head of Haematology, Haemato-Oncology and BMT at Fortis Shalimar Bagh, Delhi.