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Treatments & Programs

What happens during CAR T‑cell therapy treatment?

Dr. Stephen Wrzesinski, Director of Immunooncology and Cellular Therapy at NYOH, explains how patients are treated using CAR T-cell therapy.

 

UNDERSTANDING CAR T-CELL THERAPY

CAR T-CELL THERAPY is a form of immunotherapy, a groundbreaking form of cancer treatment that utilizes the patient’s own immune cells to fight cancer. CAR stands for chimeric antigen receptor (CAR) T-cell therapy, because it involves altering the patient’s own T-cells to hunt and attack cancer cells.

WATCH THE VIDEO to understand how the body uses CAR T-cells to destroy cancer.

 

Remove blood from patient to retrieve T-cells.

Your T-cells are removed using a procedure called leukapheresis. Two IV lines are inserted into your body and blood is drawn via one IV, but is returned to the body, after T-cells are removed, through the second.

Make CAR T-cells in the lab

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

Grow millions of CAR T-cells

Because large numbers of CAR T-cells are used, it often takes several weeks for enough modified cells to reproduce. They are then shipped back to NYOH so they can be returned to your body.

Open up space in immune system for CAR T-cells

Before the CAR T-cell infusion you will likely receive chemotherapy. This helps 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.

Infuse CAR T-cells into 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 measure the effectiveness of the treatment.

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.

FREQUENTLY ASKED QUESTIONS ABOUT CAR T‑CELL THERAPY

  • What is CAR T-cell therapy?

    CAR T-cell therapy is a form of immunotherapy, a groundbreaking form of cancer treatment that utilizes the patient’s own immune cells to fight cancer. “CAR” refers to chimeric antigen receptor. This is a customized immune cell, created in a laboratory, that can attach to specific proteins on a type of cancer cell. The process alters a patient’s own T-cells to hunt and attack specific cancer cells.

    New York Oncology Hematology is the only provider in our region currently offering CAR T-cell therapy for cancer patients.

    Courtney M. Bellomo, M.D.

    Courtney M. Bellomo, M.D.

    Hematology and Stem Cell Transplant,
    New York Oncology Hematology
    Clinical Assistant Professor of Medicine,
    Albany Medical College

    Stephen Wrzesinski, M.D., Ph.D.

    Stephen Wrzesinski, M.D., Ph.D.

    Director of Immunooncology and Cellular Therapy
    Medical Oncology, New York Oncology Hematology
    Clinical Assistant Professor of Medicine,
    Albany Medical College

  • How does CAR T-cell therapy work?

    To understand CAR T-cell therapy, it starts with how the immune system functions. Our bodies have several different cells, including thymus cells (T-cells), that work together to fight off foreign substances. The immune system is pretty sophisticated – it figures out something does not belong in the body by searching the proteins on the surface of that foreign cell called antigens.

    Some of our body’s immune cells (including T-cells) have their own proteins, known as receptors. These ahere 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 is able to bind to it. While cancer cells do have antigens, our immune systems can have difficulty identifying and destroying a cancer cell.

    In CAR T-cell therapy, we remove the body’s own T-cells (by 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's antigen – the key that only opens one kind of lock. The patient's own T-cells used to make the CAR T-cells are returned to the body to fight the cancer.

    Courtney M. Bellomo, M.D.

    Courtney M. Bellomo, M.D.

    Hematology and Stem Cell Transplant,
    New York Oncology Hematology
    Clinical Assistant Professor of Medicine,
    Albany Medical College

    Stephen Wrzesinski, M.D., Ph.D.

    Stephen Wrzesinski, M.D., Ph.D.

    Director of Immunooncology and Cellular Therapy
    Medical Oncology, New York Oncology Hematology
    Clinical Assistant Professor of Medicine,
    Albany Medical College

  • Who is eligible to receive CAR T-cell therapy?

    CAR T-cell therapy is currently FDA approved as standard of care for a few forms of aggressive non-Hodgkin's lymphoma 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.

    Your physician can make a referral and set up an evaluation for you by calling NYOH’s Albany Medical Center office at: 518-262-6696.

    Courtney M. Bellomo, M.D.

    Courtney M. Bellomo, M.D.

    Hematology and Stem Cell Transplant,
    New York Oncology Hematology
    Clinical Assistant Professor of Medicine,
    Albany Medical College

    Stephen Wrzesinski, M.D., Ph.D.

    Stephen Wrzesinski, M.D., Ph.D.

    Director of Immunooncology and Cellular Therapy
    Medical Oncology, New York Oncology Hematology
    Clinical Assistant Professor of Medicine,
    Albany Medical College

  • Where can I get CAR T-cell therapy?

    In our region, NYOH is the only cancer center authorized to provide CAR T-cell therapy.

    Because it requires highly specialized expertise and is personalized to each patient, it is offered in a very limited number of cancer centers across the country. Patients would need to travel more than 150 miles to New York, Boston or Connecticut for the next closest provider.

    Currently NYOH is only providing this treatment as part of clinical trial.

    Courtney M. Bellomo, M.D.

    Courtney M. Bellomo, M.D.

    Hematology and Stem Cell Transplant,
    New York Oncology Hematology
    Clinical Assistant Professor of Medicine,
    Albany Medical College

    Stephen Wrzesinski, M.D., Ph.D.

    Stephen Wrzesinski, M.D., Ph.D.

    Director of Immunooncology and Cellular Therapy
    Medical Oncology, New York Oncology Hematology
    Clinical Assistant Professor of Medicine,
    Albany Medical College

  • Does insurance cover CAR T-cell therapy?

    Because this is a brand new, emerging treatment option, most health insurance plans are currently working on their coverage policies for FDA-approved therapies. Like any new therapy, coverage is currently reviewed on a case-by-case basis. There is no coverage for clinical trials for CAR T-cell therapy, but NYOH works closely with our eligible patients to create a plan to receive the treatment.

    Courtney M. Bellomo, M.D.

    Courtney M. Bellomo, M.D.

    Hematology and Stem Cell Transplant,
    New York Oncology Hematology
    Clinical Assistant Professor of Medicine,
    Albany Medical College

    Stephen Wrzesinski, M.D., Ph.D.

    Stephen Wrzesinski, M.D., Ph.D.

    Director of Immunooncology and Cellular Therapy
    Medical Oncology, New York Oncology Hematology
    Clinical Assistant Professor of Medicine,
    Albany Medical College

  • What are the steps for CAR T-cell treatment?

    Timing

    Once a patient is evaluated and deemed eligible, the actual process for the collection of 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 patient to retrieve T-cells: Your T-cells are removed using a procedure called leukapheresis. You will lie in bed or sit in a reclining chair, and two IV lines are inserted into your body. Blood is drawn via one IV, but is then returned to the body, after T-cells are removed, through the second. Sometimes a special type of IV line is used called a central venous catheter, that has both IV lines built in.

    You need to remain still for 2 to 3 hours to complete the process. During leukapheresis, calcium levels can sometime drop. This can cause numbness and tingling or muscle spasms. However, we can easily treat this by providing 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. Here, 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 for enough of the new, modified cells to reproduce. Once a sufficient amount are created, the CAR T-cells are returned to NYOH and we schedule a time for them to be returned to your body to seek and destroy specific cancer cells.

    Step four

    Open up space in 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 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.

    Courtney M. Bellomo, M.D.

    Courtney M. Bellomo, M.D.

    Hematology and Stem Cell Transplant,
    New York Oncology Hematology
    Clinical Assistant Professor of Medicine,
    Albany Medical College

    Stephen Wrzesinski, M.D., Ph.D.

    Stephen Wrzesinski, M.D., Ph.D.

    Director of Immunooncology and Cellular Therapy
    Medical Oncology, New York Oncology Hematology
    Clinical Assistant Professor of Medicine,
    Albany Medical College

  • Are there side effects with CAR T-cell therapy?

    Like any major cancer treatment, some patients do experience side effects. Often, this occurs during the time the CAR T-cells are multiplying 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 in the days just after 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 potential 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 to monitor patients to uncover any long-term impact on their bodies.

    Because the side effects can be life threatening, our CAR T-cell therapy team will spend time educating patients and their loved ones on symptoms and signs to watch for. Notifying the doctor quickly 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.

    Courtney M. Bellomo, M.D.

    Courtney M. Bellomo, M.D.

    Hematology and Stem Cell Transplant,
    New York Oncology Hematology
    Clinical Assistant Professor of Medicine,
    Albany Medical College

    Stephen Wrzesinski, M.D., Ph.D.

    Stephen Wrzesinski, M.D., Ph.D.

    Director of Immunooncology and Cellular Therapy
    Medical Oncology, New York Oncology Hematology
    Clinical Assistant Professor of Medicine,
    Albany Medical College

  • How can I find out if I am eligible for CAR T-cell therapy?

    To learn more or to schedule an evaluation, we recommend asking your physician for a referral to NYOH for a CAR T-cell therapy evaluation. A referral from your current physician is required to begin this process. Your physician can make a referral and set up an evaluation for you by calling NYOH’s Albany Medical Center office at: 518-262-6696.

    Courtney M. Bellomo, M.D.

    Courtney M. Bellomo, M.D.

    Hematology and Stem Cell Transplant,
    New York Oncology Hematology
    Clinical Assistant Professor of Medicine,
    Albany Medical College

    Stephen Wrzesinski, M.D., Ph.D.

    Stephen Wrzesinski, M.D., Ph.D.

    Director of Immunooncology and Cellular Therapy
    Medical Oncology, New York Oncology Hematology
    Clinical Assistant Professor of Medicine,
    Albany Medical College

  • Why is NYOH the only provider in the region offering CAR T-cell therapy?

    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.

    CAR T-cell therapy is a highly specialized process, requiring a dedicated, expert team. Because NYOH offers the region's only stem cell transplant program, our specialists are well-equipped to also offer CAR T-cell therapy.

    In 2019, Stephen Wrzesinski, MD, PhD, joined the NYOH team as Director of Immunooncology and Cellular Therapy, because we recognized that other types of cancer may soon become eligible for CAR T-cell therapy. An immune therapy specialist, Dr. Wrzesinski will provide expert care, while also expanding the program to assist as many patients as possible.

    Courtney M. Bellomo, M.D.

    Courtney M. Bellomo, M.D.

    Hematology and Stem Cell Transplant,
    New York Oncology Hematology
    Clinical Assistant Professor of Medicine,
    Albany Medical College

    Stephen Wrzesinski, M.D., Ph.D.

    Stephen Wrzesinski, M.D., Ph.D.

    Director of Immunooncology and Cellular Therapy
    Medical Oncology, New York Oncology Hematology
    Clinical Assistant Professor of Medicine,
    Albany Medical College

  • Is CAR T-cell available at all of your NYOH locations?

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

    Courtney M. Bellomo, M.D.

    Courtney M. Bellomo, M.D.

    Hematology and Stem Cell Transplant,
    New York Oncology Hematology
    Clinical Assistant Professor of Medicine,
    Albany Medical College

    Stephen Wrzesinski, M.D., Ph.D.

    Stephen Wrzesinski, M.D., Ph.D.

    Director of Immunooncology and Cellular Therapy
    Medical Oncology, New York Oncology Hematology
    Clinical Assistant Professor of Medicine,
    Albany Medical College

TALK WITH YOUR PHYSICIAN about your eligibility and treatment options. NYOHCART@usoncology.com or 518-262-6696

I am thrilled that NYOH is now offering CAR T-cell therapy.

While I am so grateful CAR T-cell was successful in treating my cancer, it wasn’t easy traveling to Boston for the therapy. I was away from my home and family for several weeks in a hospital. Not everyone could have done it. Now, cancer patients like me can receive CAR T-cell close to home. That’s a big deal. We are fortunate to have a practice of the caliber of New York Oncology Hematology, with doctors who have the experience and ability to bring CAR T-cell to our community.

ALBA M., ALBANY, NY LYMPHOMA SURVIVOR AND CAR T-CELL RECIPIENT