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Chimeric Antigen Receptor (CAR) T-cell Therapy is a cutting-edge treatment that is bringing hope to many patients with Acute Lymphoblastic Leukemia (ALL) and Diffuse Large B-cell Lymphoma (DLBCL). We break down how it works and what the cancer treatment journey looks like for patients receiving treatment.

(Step 1) Screening and collection of T-cells

The patient will first undergo screening and a series of tests to determine if CAR T-cell Therapy is an appropriate treatment option for their disease, and to ensure that the patient is fit to undergo treatment.

White blood cells, which include T-cells, will be extracted from the patient’s blood using a procedure called leukapheresis. During this procedure, two intravenous infusion (IV) lines will be inserted into the patient: blood is extracted through one line, to allow the white blood cells to be separated out and extracted, while the rest of the blood is returned to the patient’s body through the second line.

Generally, leukapheresis is a safe procedure and will not affect the patient’s health. However, patients are advised to get adequate rest with only gentle exercises for 2–3 days after the procedure. Bridging treatment may also be required after the procedure to control the disease while waiting for the CAR T-cells to be infused (in Step 4).

(Step 2) Making the CAR T-cells

When the white blood cells have been extracted, the T-cells will be separated out and sent to the laboratory to be altered. This alteration is carried out by adding the specific CAR gene to the T-cells, hence modifying them into CAR T-cells. These cells will then be grown and multiplied in the laboratory.

Under normal circumstances, it can take 2–3 weeks to produce the adequate number of CAR T-cells required for CAR T-cell Therapy.

(Step 3) Preparing the body for infusion

A short chemotherapy cycle, called lymphodepletion, will be administered a few days before the infusion of CAR T-cells. This is done to lower the number of other immune cells in the body and prepare the body to receive the CAR T-cells.

(Step 4) Infusion of CAR T-cells

When enough CAR T-cells have been produced, the product will be shipped back to the hospital to be infused into the patient.

Once the CAR T-cells begin binding with cancer cells in the body, they will begin to increase in number and destroy even more cancer cells.

(Step 5) Recovery and follow-up

Patients receiving CAR T-cell Therapy will have an early recovery period of approximately 6–8 weeks. During this period, patients will be monitored for any side effects and assessed on treatment response.

Foreign patients will be required to be in Singapore throughout the entire process, which usually takes about 3–4 months from screening to recovery, depending on their individual condition.

CAR T-cell Therapy remains a highly effective treatment that offers improved life expectancy compared to conventional chemotherapy, and brings hope to patients whose diseases have previously failed to respond to most cancer therapies.