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CAR-T Cell therapy is a form of immunotherapy that is effective in treating Myeloma, Acute Lymphoblastic Leukaemia (ALL), and Non-Hodgkins Lymphoma (NHL). Having been recently approved in Singapore, CFCH is pleased to offer this service to patients who have failed to respond to most traditional cancer therapies. Schedule an appointment with our haematologists to understand if CAR-T Cell therapy is a suitable treatment option for you.
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Table of Contents

1 What is CAR T-cell Therapy?
2 What are CAR T-cells?
3 What types of conditions can benefit from CAR T-cell therapy?
4 The Process of CAR T-cell Therapy
5 What are the side effects of CAR T-cell therapy?
6 What is the prognosis of using CAR T-cell therapy for patients with lymphoma or other blood cancers?
7 FAQs on CAR T-cell Therapy
8 FAQs on Cancers That CAR T-cell Therapy Treats

What is CAR T-cell Therapy?

CAR T-cell therapy is a form of therapy which utilises modified patient cells or new, healthy cells from a donor to replace ineffective or missing cells in patients. CAR T-cell therapy involves collecting a patient’s immune cells and modifying them in a laboratory to target against specific cancer cells. These modified cells are then returned into the patient to strengthen their immune system against the cancer cells. This treatment is effective against some forms of blood cancers in children and adults.
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What are CAR T-cells?

T-cells, also called T-lymphocytes, are white blood cells developed from healthy stem cells in the bone marrow and form a part of the body’s immune system to identify and fight abnormal cells, including cancer cells..

These T-cells can be collected from the body and genetically modified in a laboratory. The modified T-cells have special receptors on their surfaces, to target particular proteins or antigens on cancer cells. These receptors are called Chimeric Antigen Receptors, and the modified T-cells are called CAR T-cells.

These CAR T-cells then attach to the cancer cells and destroy them more effectively:

What types of conditions can benefit from CAR T-cell therapy?

CAR T-cell therapy is particularly effective for patients diagnosed with Myeloma, aggressive forms of ALL (Acute Lymphoblastic Leukaemia), and high-grade NHL (Non-Hodgkin Lymphoma)..

Relapse of non-Hodgkin lymphoma such as diffuse large B-cell lymphoma can be managed with CAR T-cell therapy, especially when at least two prior treatment regimens have failed to produce the desired outcomes..

Several research studies are being conducted to assess the effectiveness of Cellular Therapy against other forms of leukaemia and solid tumours.
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The Process of CAR T-cell Therapy

CAR T-cell therapy involves the following phases:

Evaluation: The patient undergoes a series of tests to evaluate if CAR T-cell therapy is an appropriate option.
Collection: The T-cells are collected from the patient’s blood. The procedure is known as apheresis or leukapheresis.
Engineering: The collected T-cells are sent to a laboratory to be genetically engineered into the CAR T-cells.
Multiplication: The modified CAR T-cells are grown and multiplied in the laboratory. These cells are then frozen and sent back to the clinic for the treatment. This process of multiplying the CAR T-cells can take several weeks.
Conditioning: Before the new CAR T-cells are infused into the patient’s body, the patient will have a brief course of chemotherapy. This will help to improve the chances of the body accepting the new CAR T-cells.
Infusion: Shortly after the chemotherapy, the modified CAR T-cells are infused into the patient through a process similar to a blood transfusion.
Recovery: After the CAR T-cell infusion, the patient may experience some side effects for the first 30 days after the infusion, and the recovery of the body’s immune system may take several months.
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What are the side effects of CAR T-cell therapy?

The common side effects of CAR T-cell therapy include:

Cytokine release syndrome
In some cases, patients may develop flu-like symptoms such as fever, chills, headache, nausea, vomiting, loose stools, and muscle or joint pains. It may also cause low blood pressure, difficulty in breathing, and a fast heart rate. These side effects are due to the release of cytokines by the immune cells during CAR T-cell therapy. These symptoms are usually mild, but can be serious and life threatening in some patients.
Neurological events
Neurological events can occur and can be serious in some patients. Such events include encephalopathy (brain injury and malfunction), confusion, difficulty speaking, agitation, seizures, drowsiness, altered state of consciousness and loss of balance.
Neutropaenia and Anaemia
Some patients may develop neutropenia or low white cell count. Similarly, anaemia or low red blood cell count may also occur due to this therapy.

What is the prognosis of using CAR T-cell therapy for patients with lymphoma or other blood cancers?

The results of CAR T-cell therapy for the management of lymphoma and other blood cancers have been highly encouraging. Many patients with a history of relapse of blood cancers achieved successful outcomes without any signs of cancer after CAR T-cell therapy. It has also helped to improve the recovery of patients in whom other conventional cancer treatments failed to produce the desired response..

However, longer-term trials with more substantial participation of patients are needed to confirm the effectiveness of this therapy. Large scale trials will also help to assess the possibility of developing side effects and the best ways to manage them.

FAQs on CAR T-cell Therapy

What is Cellular Therapy used for?

Cellular Therapy is a form of medical therapy which uses fresh or modified human cells for therapy.

In the context of cancer, the most established form of Cellular Therapy is the use of bone marrow stem cells for haematopoietic stem cell transplantation. More recently, a novel form of Cellular Therapy known as CAR-T cell therapy has been introduced into clinical practice. The present forms of CAR-T have been shown to be effective against some forms of blood cancers in children and adults.

What are the types of Cellular Therapy for cancer?

The established forms of Cellular Therapy for blood cancers involve the use of patient or donor bone marrow stem cells for bone marrow transplantation. These therapies generally involve little or no manipulation of the bone marrow stem cells.

Several new innovative forms of Cellular Therapy are now being developed for cancer therapy. These involve the isolation of specific cells in the body known to have an enhanced effect against cancer cells or the manipulation/modification of cells from a patient or donor to improve the immune system’s ability to attack cancer cells.

What is the difference between cell therapy and immunotherapy?

Immunotherapy is a form of cancer therapy which enhances or modifies the body’s immune system to better attack cancer cells. Cell therapy is a form of immunotherapy. It is also known as cellular immunotherapy or adoptive Cellular Therapy.

CAR-T cell therapy is a form of cell therapy that involves collecting a patient’s immune cells and modifying them in a laboratory to target specific cancer cells. The modified cells are then returned to the patient in order to strengthen their immune system against cancer cells.

Who is a suitable candidate for CAR T-cell therapy?

CAR-T cell therapy is presently licensed in Singapore for patients diagnosed with Acute Lymphoblastic Leukaemia (ALL) up to the age of 25, or adult aggressive B-cell lymphoma who have already undergone two lines of unsuccessful treatment.

Our haematologists at CFCH will be able to give you more information as to whether or not you are a suitable candidate for CAR T-cell therapy.

Is CAR-T cell therapy covered by insurance?

At present, some but not all insurance companies provide coverage for the cost of CAR-T cell therapy. We recommend you seek clarification with your insurance company on the specific coverage for Cellular Therapy.

What is the success rate of CAR T-cell therapy?

The long-term success rate of CAR T-cell in the treatment of relapsed/refractory B-cell lymphoma is about 30% to 40%, and more than 50% in relapsed or refractory B-cell Acute Lymphoblastic Leukaemia (ALL).

Is CAR-T cell therapy safe?

The use of CAR-T cell therapy can be associated with notable side effects. Some patients can develop serious neurological side effects, and others can have side effects related to cytokine release syndrome (due to the sudden release of chemicals when the CAR-T cells are infused into a patient).

Some patients will need to be admitted to intensive care for monitoring. However, in recent years the management of the side effects of CAR-T cell therapy has improved significantly.

Is CAR T-cell therapy a last resort?

CAR T-cell therapy requires patients to have strong organ functions as the process can put a strain on the body. Additionally, CAR T-cell therapy is generally reserved for patients who have undergone at least two prior treatment lines that have proven unsuccessful.

Is CAR T-cell therapy a bone marrow transplant?

No CAR-T cell therapy is not a form of bone marrow transplant.

Some patients who receive some forms of CAR-T cell therapy may require an allogeneic bone marrow transplantation after to consolidate their treatment and reduce the risk of long-term relapse.

FAQs on Cancers That CAR T-cell Therapy Treats

At CFCH, we offer cellular therapy for certain blood cancers including Acute Lymphoblastic Leukaemia (ALL) and Lymphoma.

When do we use CAR-T cell therapy in ALL?

CAR T-cell therapy is a form of immunotherapy that involves collecting a patient’s immune cells and modifying them in a laboratory to target specific cancer cells. These modified cells are then returned to the patient to strengthen their immune system against the cancer cells. It may be used in the treatment of Acute Lymphoblastic Leukaemia when two prior treatment options have proven unsuccessful.

When do we use CAR-T cell therapy in Lymphoma?

CAR-T cell therapy has been shown to be effective in patients with B-cell Lymphoma who have relapsed or refractory diffuse large B-cell Lymphoma, transformed follicular Lymphoma, as well as primary mediastinal B-cell Lymphoma.

In Singapore, the current approved form of CAR-T cell therapy is indicated for patients with diffuse large B-cell Lymphoma who have previously failed at least 2 lines of standard treatment.

How does CAR T-cell therapy treat Myeloma?

CAR T-cell treatment is able to modify a patient’s immune cells in a laboratory to target against the abnormal cancer cells. In the case of Myeloma, that would be the affected plasma cells in the bone marrow.