The Region's Only Provider of CAR-T Therapy

To understand CAR-T, we have to start by understanding how our immune system functions. Our bodies have several different cells, including T lymphocytes (T-cells), that work together to fight off foreign substances. The immune system is pretty sophisticated. It figures out what does not belong in the body by searching for proteins on the surface of foreign cells, called antigens.

Some of our body's immune cells (including T-cells) have their own proteins, known as receptors. These receptors adhere to a foreign antigen, helping trigger other parts of the immune system to ramp up to eliminate the foreign substance. Antigens and immune receptors operate like a lock and key—each foreign antigen has just one immune receptor that can bind to it. While cancer cells do have antigens, our immune systems can have difficulty identifying and destroying a cancer cell.

In CAR-T therapy, we remove the body's own T-cells (blood draw) and send them to a lab, where they are altered with a man-made receptor that helps better identify and destroy the specific cancer cell. The receptor is called a chimeric antigen receptor or CAR. Since different cancers have different antigens, each CAR is made for a specific cancer antigen – the key that only opens one lock. The patient's own T-cells are used to make the CAR T-cells, which are returned to the body to fight the cancer.

CAR T-cell therapy is currently FDA-approved as the standard of care for a few forms of  non-Hodgkin lymphoma, Multiple Myeloma and leukemias resistant to prior therapies.  

However, there are many ongoing trials of CAR T-cell therapy for other forms of blood cancer, and some of these are offered at NYOH. We recommend asking your physician for a referral to NYOH for a CAR T-cell therapy evaluation. You must have a physician referral to start this process. 

Please have your physician place a referral to learn more or schedule an evaluation. 

NYOH is the only cancer center authorized to provide CAR T-cell therapy in our region. Due to its highly specialized expertise and personalized approach for each patient, this service is available at a limited number of cancer centers nationwide. Outside of the Capital Region, Patients would have to travel over 150 miles to reach the nearest providers in New York, Boston, or Connecticut.

As this is a new, emerging treatment option, most health insurance plans are developing their coverage policies for FDA-approved therapies. Like any new therapy, coverage is currently assessed on a case-by-case basis. NYOH collaborates closely with our eligible patients to formulate a plan for receiving the treatment.  

Timing: Once a patient is evaluated and deemed eligible, the process for collecting t-cells, receiving chemotherapy followed by CAR T cell therapy and monitoring for early signs of side effects lasts several weeks. 

Step one: Remove blood from the patient to retrieve T-cells. 
Your T-cells are removed using a procedure called apheresis. You will have a special type of IV line inserted by a radiologist before the procedure, called a central venous catheter, with both IV lines built in, which you will need for the procedure. You will sit in a reclining chair, and blood is drawn via one IV but is then returned to the body after T-cells are removed through a second. 

You need to remain still for two to three hours to complete the process. During apheresis, calcium levels can sometimes drop. This may cause numbness and tingling or muscle spasms. However, we can easily treat this with calcium supplements, either by mouth or through an IV. 

Step two: Make CAR T-cells in the lab.
Once your white cells are removed and the T-cells are separated, they are sent to a highly specialized lab. Then, the cells are genetically modified to express the specific chimeric antigen receptor (CAR) to become CAR T-cells. 

Step three: Grow millions of CAR T-cells.
Because the therapy requires large numbers of CAR T-cells, it often takes several weeks at the lab to reproduce enough of the new, modified cells. Once a sufficient amount is created, the CAR T-cells are returned to NYOH, and we will schedule a time for them to be returned to your body to seek and destroy specific cancer cells. 

Step four: Open up space in the immune system for CAR-T cells. 
Before the CAR T-cell infusion, you will likely receive chemotherapy. This is done to help lower the number of other immune cells in the body and 'make room' for the CAR T-cells to get activated and multiply to fight the cancer.  

Step five: Infuse CAR T-cells into the patient. 
CAR T-cells are reintroduced via infusion, or IV, which typically takes about an hour. You will be closely monitored and checked regularly for several weeks for any side effects and to gauge the effectiveness of the treatment. 

Step six: CAR T-cells bind to cancer cells and kill them.
Once the CAR T-cells start binding with cancer cells, they begin multiplying to prepare to destroy even more cancer cells. Because this process can cause side effects, patients are closely monitored during this time. 

Like any major cancer treatment, some patients do experience side effects. Often, this occurs when the CAR T-cells multiply in the body to prepare to destroy the cancer. 

Very high fevers and dangerously low blood pressure are the most common serious side effects. They typically occur on the days just after the infusion of the modified T-cells. This is called cytokine release syndrome, or CRS. Doctors can manage the side effects, often with temporary hospitalization. 

Other potentially serious side effects include neurotoxicity or changes in the brain that cause confusion, seizures, or severe headaches. Also, serious infections, low blood cell counts and a weakened immune system can occur following initial treatment. Chills, shaking, nausea, vomiting and diarrhea are also reported. 

While these are the known side effects, CAR T-cell therapy is a new treatment, and doctors continue monitoring patients to uncover any long-term impacts on their bodies. 

Because the side effects can be life-threatening, our CAR T at NYOH team members with expertise in this therapy spend time educating patients and their loved ones on symptoms and signs to watch for. Quickly notifying the doctor is important to help manage these conditions. 

For this reason, patients are closely monitored for several months, and NYOH offers 24-hour access to our CAR T-cell team.

We recommend asking your physician for a referral to NYOH for a CAR T-cell therapy evaluation. You must have a physician referral to start this process. Please have your physician reach out to us directly.

NYOH is the only provider in the Capital District with the expertise to offer this highly specialized cellular therapy. In the past, patients needed to travel several hours to receive the treatment and were often required to live in places like New York City and Boston for weeks.

Currently, NYOH offers CAR T at our Albany Medical Center location. This is due to the infrastructure necessary to provide the best possible experience for patients throughout the therapy.