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Chimeric antigen receptor (CAR) T-cell therapy is a type of cancer immunotherapy. It helps the body’s own immune system find and attack cancer cells. CAR T-cell therapy is also sometimes talked about as a type of cell-based gene therapy, because it involves altering the genes inside certain immune cells to help them attack the cancer.

Some CAR T-cell therapies can be used to treat multiple myeloma.

How is CAR T-cell therapy done?

Immune cells called T cells are taken from the person’s blood during a process called leukapheresis. Blood is removed through an IV line and goes into a machine that takes out the T cells. The remaining blood then goes back into the person's body. This process typically takes a few hours, and it might need to be repeated. 

The T cells are then frozen and sent to a lab, where they are genetically altered so they have specific receptors (called chimeric antigen receptors, or CARs) on their surface. These receptors help the T cells attach to proteins on cancer cells. The T cells are then multiplied in the lab, which typically takes several weeks.

Once the CAR T cells are ready, the patient gets chemotherapy for a few days to help prepare the body for the treatment. Then the CAR T cells are infused back into the patient’s blood, where they can seek out the cancer cells and help the immune system attack them.

CAR T-cell treatments for multiple myeloma

Idecabtagene vicleucel (ide-cel, Abecma) and ciltacabtagene autoleucel (cilta-cel, Carvykti) are CAR T-cell therapies that target the BCMA protein, which is found on myeloma cells. Either of these treatments can be used in people who have already received several other types of medicines to treat their multiple myeloma.

Possible side effects of CAR T-cell treatments

These treatments can have serious or even life-threatening side effects, so they need to be given in a medical center that is specially trained in their use.

Cytokine release syndrome (CRS): CRS can happen when T cells release chemicals (cytokines) that ramp up the immune system. CRS most often happens within a few days to weeks after treatment, and in some cases it can be life-threatening. Symptoms can include:

• High fever and chills
• Trouble breathing
• Severe nausea, vomiting, and/or diarrhea
• Feeling dizzy or lightheaded
• Headaches
• Fast heartbeat
• Feeling very tired

Nervous system problems: This treatment can sometimes have serious effects on the nervous system, which can result in symptoms such as:

• Headaches
• Changes in consciousness
• Confusion or agitation
• Seizures
• Shaking or twitching (tremors)
• Trouble speaking and understanding
• Loss of balance

Because of the risk of these side effects, you’ll be advised not to drive, operate heavy machinery, or do any other potentially dangerous activities for at least 8 weeks after you get your treatment.

Other serious side effects: Other possible serious side effects can include:

• Allergic reactions during the infusion
• A weakened immune system
• An increased risk of serious infections
• Low blood cell counts, which can increase the risk of infections, fatigue, and bruising or bleeding

Your health care team will watch you closely for several weeks after you get the CAR T cells. It’s very important to report any side effects to your health care team right away, as there are often medicines that can help treat them.

To learn more about this type of treatment, see CAR T-cell Therapy and Its Side Effects.