Chimeric antigen receptor T-cell (CAR-T) therapy is a form of adoptive cell immunotherapy offered to patients with certain haematological malignancies that have not achieved remission with chemotherapy or stem cell transplantation. In brief, the patient’s own T cells are harvested and subjected to genetic engineering to add a chimeric antigen receptor directed towards malignant cells. Modified CAR-T cells are infused back into the patient, whereupon they mediate a targeted immune response including stimulation of inflammatory cytokines to destroy circulating malignant cells and hopefully achieve disease control1. CAR-T therapy has significantly improved survival in patients with haematological malignancies2.
CAR-T therapy is delivered in specialist haematology centres in the UK. Patients undergoing this therapy remain in hospital for at least two weeks following infusion due to a risk of life-threatening complications, for which organ support is required for around 25-30% of patients3. Some toxicities relating to CAR-T therapy have a delayed presentation, meaning these patients may present to a non-specialist centre. Fortunately, complications relating to CAR-T therapy are often reversible, and treatment-related mortality is less than 5%.
Some examples of CAR-T products include axicabatagene (Yescarta) and tisagenlecleucel (Kymriah).
