Having CAR T-cell therapy

What happens during CAR-T therapy?

You’ll go through some preparation first before having CAR T-cell therapy. You can read more about this on our Preparing for CAR T-cell therapy webpage.

There are three main stages of having CAR-T therapy:

1. Collecting your T cells using an apheresis machine
2. Making your CAR T-cells in a laboratory
3. Infusion day, when your new CAR T-cells are put into your bloodstream

We’ll explain each of these stages in detail on this webpage.

Collecting your T cells

Your T cells will be collected during a common procedure called leukapheresis. It may need to be done over two days to make sure enough T cells are collected.

1. You'll have a needle and thin tube (cannula) put into a vein in each arm (or you may have a central line in your chest or groin).
2. Your blood will be taken out of one arm and go into an apheresis machine.
3. The apheresis machine will separate your T cells from the rest of your blood.
4. The rest of your blood will be returned to your other arm.
5. Your T cells are then sent to the laboratory where your treatment is made.

This procedure can take a few hours so remember to bring things to keep you busy, like a book, a tablet or laptop, or hobbies. You can read more ideas on our Preparing for CAR T-cell therapy webpage.

You might feel a bit tired during or after leukapheresis, but you should feel OK otherwise. Make sure you tell your medical team if you have any worries or feel uncomfortable at any time.

Making your CAR T-cells

Your T cells will be sent to a laboratory to form your treatment. You can read more about what this means on our What is CAR T-cell therapy? webpage.

At the laboratory:

1. Scientists will create your new CAR T-cells by modifying the DNA of your T cells.
2. The cells will then be grown until there are enough of them to form your treatment. This can take a few weeks.
3. When your CAR T-cells are ready, they will be frozen and sent back to the hospital, ready for you to receive.

You might have bridging treatment while your CAR T-cells are being made.

You will also have a course of chemotherapy about a week before you receive your CAR T-cells. This is called lymphodepletion.

Read more about bridging treatment and chemotherapy on our Preparing for CAR T-cell therapy webpage.

Infusion day

You will receive your CAR T-cells in hospital. Your CAR T-cells will be thawed (defrosted) and a specially trained nurse will give them to you through your central line, PICC line or cannula. This is called infusion. It’s a similar process to having a blood transfusion and should take about 15-30 minutes.

You will be given medication before the infusion to prevent any allergic reactions or fevers.

What happens next?

You’ll be monitored in hospital for about 10-14 days while you recover after your infusion.

You can be discharged if:

• you have recovered from any side effects
• you are no more than a drive of 1-2 hours — depending on your hospital’s guidelines — from the hospital (in case you experience any side effects)
• you have someone to care for you at home full-time.

If you do not meet the above criteria, you will stay in hospital for at least 28 days after your infusion.

Short-term side effects to look out for

There are some acute side effects which are more likely to occur in the first 28 days after your infusion day:

• Cytokine release syndrome (CRS)
• Immune effector-cell associated neurotoxicity syndrome (ICANS)
• Tumour lysis syndrome (TLS)

Your medical team will be monitoring you for any signs of the above side effects while you are still in hospital. You can read more about these side effects, plus others, and what to expect during your recovery on our Recovering from CAR T-cell therapy webpage.

• This information was developed in partnership with Blood Cancer UK