CAR-T cell therapy

Consultants 

Haemato-Oncologists

Dr Muhammad Saif – Stem Cell Transplant and Cellular Therapy Programme Director 
Dr Shahid Iqbal
Dr Sajid Pervaiz
Dr Tom Seddon
Dr Gabe Toth
Dr Matt Wells

Nurses 

Service Lead

Priscilla Hetherington

Advanced Nurse Practitioner

Sally Pickering

CAR-T Coordinator Nurse

Fiona Scanlon 

Ward 5 nursing team

Referral 

CAR-T therapy is very specialist and is only available for some types of cancer. It is an intensive treatment with potential side-effects that can be serious. This means CAR-T therapy is not suitable for anyone who is too frail. 

Your doctor will know whether CAR-T could be an option for you as an approved NHS treatment or on a clinical trial. 

If they think you are suitable, they will refer you to see our CAR-T consultants and specialist teams. 

Initial consultation and assessments

At your appointment with our CAR-T specialists, they will explain what treatment involves and arrange tests to check you are suitable and that it would be safe for you to have this treatment.

These tests will include:

• Physical examination, tests and scans to check your pulse, heart rate, breathing and so on. 
• Blood tests to check how well your liver and kidneys are working and to check for any signs of infection.
• Blood tests for viruses such as Hepatitis B and C, HIV or syphilis – this is a legal requirement. 
• You might also need other tests, scans or biopsies so we have up-to-date information about your cancer. 

If you are eligible, your CAR-T specialist team will discuss your situation with a national panel of experts. The panel considers your general health, or 'performance status', as well as the results of any tests and scans to help them decide if CAR-T cell therapy is suitable for you.

Cell collection and pre-treatment

The next step is to collect your T cells and prepare your body for CAR-T therapy. 

Collecting your T cells is called ‘apheresis’. This will take place in the Therapeutic Apheresis suite on Level 1 of Clatterbridge Cancer Centre – Liverpool. A nurse will put tubes into a vein in each arm. 

One tube takes blood from your arm to an apheresis machine that separates the blood cells. The machine collects your T cells. The rest of your blood goes back into your other arm through the second tube. 

Your T cells go to a special laboratory to be made into CAR-T cells for your treatment. This takes 4 to 6 weeks.

In the meantime, you might need chemotherapy or radiotherapy to control your cancer and make sure your body is ready for CAR-T therapy. This is known as ‘bridging therapy’. 

You will have a PET-CT scan three weeks after bridging therapy to check you are still suitable for CAR-T therapy.

Going into hospital for CAR-T therapy

You will be admitted to your own room on Ward 5 at Clatterbridge Cancer Centre – Liverpool. This is our specialist ward for cellular therapies (such as CAR-T) and stem cell transplants. You will stay there for a few weeks while you have treatment. 

You will have a PICC line (peripherally inserted central catheter) inserted if you don’t already have one – this is a tube that goes into a central vein so we can deliver your treatment through it. 

We will give you chemotherapy for 4 to 6 days to prepare your body for CAR-T therapy by reducing the number of white blood cells. This is known as ‘lymphodepletion chemotherapy’. It is given through your PICC line. 

Reducing the number of white blood cells in your body before treatment helps the CAR-T therapy to work more effectively. 

You will rest for 2 days before we give you your CAR-T therapy. Getting CAR-T cells or other blood products is known as ‘transfusion’.  

Your CAR-T transfusion 

The CAR-T cells arrive frozen so need to thaw before you have them. We will give you medicine – usually paracetamol and antihistamines (anti-allergy) – to help prevent any reaction to the new cells. 

The transfusion is given through a drip into your arm. This takes about 30 minutes. We will monitor you very carefully in case your body reacts to the treatment. 

You will stay in hospital for at least 10 days afterwards so we can check how you are recovering and make sure you are well.

CAR-T is an intensive treatment that can have lots of side-effects. Some of these side-effects can be very serious or even life-threatening. Your doctor will explain the possible side-effects to you before treatment. Two of the most serious possible side-effects are:

• Cytokine release syndrome – where your body releases cytokines that can cause many different symptoms including low blood pressure, shortness of breath, bleeding, racing heart rate, fever or nerve problems.
• Reactions affecting the brain and nervous system – CAR-T therapy can cause short-term problems with your brain and nervous system. For example, memory loss, confusion, difficulty speaking, reduced consciousness, fits or loss of coordination. 

Please tell us if you feel unwell or have any symptoms after your CAR-T therapy, even if they seem mild or unimportant.  

Your clinical team will look after you and will help you prepare to leave hospital when you are well enough. 

Leaving hospital

You will need to stay close to Liverpool for at least 28 days after your CAR-T therapy so you are nearby if you feel unwell. If you live more than an hour away, we will arrange accommodation closer to the hospital. 

You will also need to have someone with you at all times for at least 28 days after your CAR-T therapy. This is so they can check how you are, contact us if you become unwell and drive you to Clatterbridge Cancer Centre – Liverpool if you become very unwell and we need to see you. 

After this, you will have regular follow-up appointments so we can check how you are responding to the CAR-T therapy.