Chimeric antigen receptor T-cell (CAR-T) therapy; harvesting of blood-derived T lymphocytes for development of genetically modified autologous CAR-T cells, per day
CPT4 code
Name of the Procedure:
Chimeric Antigen Receptor T-Cell (CAR-T) Therapy
Technical Terms: CAR-T cell therapy, T lymphocyte harvesting, Autologous CAR-T
Summary
Chimeric Antigen Receptor T-cell (CAR-T) therapy involves collecting a patient's own T-cells (a type of white blood cell) and modifying them in a laboratory to better identify and attack cancer cells. The modified cells are then multiplied and infused back into the patient's bloodstream to help fight cancer.
Purpose
Medical Condition: CAR-T therapy is primarily used to treat certain types of blood cancers, such as acute lymphoblastic leukemia (ALL) and non-Hodgkin lymphoma (NHL).
Goals: To target and destroy cancer cells more effectively using the patient's own immune system. Expected outcomes include reduction or remission of cancer.
Indications
Symptoms/Conditions: Indicated for patients with relapsed or refractory blood cancers that have not responded to standard treatments.
Patient Criteria: Suitable for patients who are physically fit enough to undergo the procedure and have a sufficient number of viable T-cells for harvesting.
Preparation
Pre-procedure Instructions: Patients may need to undergo blood tests and assessments to ensure they are suitable candidates. They should follow specific dietary and medication guidelines provided by their healthcare team.
Diagnostic Tests: Blood work, imaging scans, and possibly a bone marrow biopsy to evaluate the extent of the cancer.
Procedure Description
- Blood Draw: The patient will undergo a procedure called leukapheresis, where blood is drawn through an IV line.
- T-Cell Isolation: T-cells are separated from the rest of the blood components using a machine.
- T-Cell Modification: The T-cells are sent to a laboratory where they are genetically modified to express chimeric antigen receptors (CARs) capable of targeting cancer cells.
Cell Multiplication: The modified T-cells are allowed to multiply until there are enough cells for therapy.
Tools and Equipment: Apheresis machine, IV lines, laboratory facilities for genetic modification.
Anesthesia or Sedation: Usually not required, but local anesthesia may be used for comfort during IV insertion.
Duration
The harvesting procedure typically takes several hours per day over one or more days.
Setting
The procedure is generally performed in a hospital or specialized outpatient clinic equipped with apheresis facilities.
Personnel
Healthcare Professionals Involved: Hematologists, oncologists, nurses, technicians, and laboratory specialists.
Risks and Complications
Common Risks: Fatigue, bruising, and infection at the IV insertion site.
Rare Risks: Low blood pressure, electrolyte imbalances, allergic reactions. Management typically involves monitoring and supportive care during the procedure.
Benefits
Expected Benefits: The potential to achieve remission or significant reduction in cancer activity.
Timeline: Benefits can be observed within weeks to months after the modified cells are infused back into the patient.
Recovery
Post-procedure Care: Patients are monitored for immediate side effects and may need additional treatment depending on their response to the therapy.
Recovery Time: Varies; patients might experience fatigue or flu-like symptoms and should avoid strenuous activities for several days. Follow-up appointments are essential.
Alternatives
Other Treatment Options: Chemotherapy, radiation therapy, bone marrow transplant.
Pros and Cons: Other treatments may not be as targeted and can have different side effect profiles. CAR-T therapy offers a more personalized approach but involves a complex preparation phase.
Patient Experience
During the leukapheresis, patients may feel mild discomfort from the IV and some fatigue. Pain management includes local anesthetics and comfort measures like blankets and pillows. After the procedure, patients might experience mild side effects and should follow their healthcare team’s recovery plan.