CAR-T Cell Therapy — Engineering the Immune System Against Blood Cancer

Who may be eligible

Eligibility depends on the disease subtype, antigen expression, prior lines of therapy, organ function and performance status. Referral should be discussed early enough to allow collection, manufacturing and bridging therapy. Patients and families need to understand the timeline, the risk of serious toxicity and the need for prolonged proximity to the treating centre.

• Confirmed antigen expression and disease subtype
• Adequate prior treatment history and organ function
• Performance status and infection assessment
• Bridging therapy planning
• Logistical and caregiver support

Infusion and toxicity monitoring

After lymphodepleting chemotherapy, the CAR-T product is infused. Cytokine release syndrome may cause fever, hypotension and hypoxia; neurological toxicity may cause confusion, seizures or speech change. Grading and prompt treatment are essential. Infection risk persists after discharge, and long-term blood count and disease monitoring continue for months.

• Lymphodepletion before infusion
• Inpatient or closely supervised outpatient monitoring
• CRS grading and treatment
• Neurological toxicity surveillance
• Infection prevention and long-term follow-up

Guidelines referenced:

• ASBMT/CIBMTR consensus on CAR-T toxicity management
• NCCN Guidelines — B-Cell Lymphomas and ALL
• ESMO Clinical Practice Guidelines — CAR-T in haematological malignancies