Ask the Nurse: CAR-T cell treatments

There’s growing interest from patients and their families in understanding what CAR-T cell treatments are and what they involve. This is because CAR-T cell treatments are often in the news and are currently being used to treat other blood cancers like non-Hodgkin lymphoma (Yescarta®) and acute lymphoblastic leukaemia (Kymriah®).

In this month’s blog, we answer some of the questions you ask our Myeloma Infoline Team about CAR-T cell treatment.

What is CAR-T cell treatment?

CAR-T cells (Chimeric Antigen Receptor-T cells) are an emerging treatment for myeloma. The treatment uses the body’s own immune system to kill myeloma cells.

T cells are a type of immune cell in the body that can identify and kill abnormal or infected cells. CAR-T cells are made by taking T-cells from the patient’s blood and genetically modifying them in a laboratory, so they are much better at finding and killing myeloma cells. The new CAR-T cells are then given back to the patient. The CAR-T cells can then find and kill the myeloma cells. CAR-T cells can stay active for long periods of time and can increase in number in response to myeloma, which may help keep myeloma under control for longer.

How do CAR-T cells work?

Every cell in our body has proteins on its surface, sometimes called markers or antigens. These help the immune system tell the difference between healthy cells and those that may be harmful. When a T cell identifies a harmful cell, it attaches to the cell (using the antigen) and either kills the harmful cell directly or sends out a signal to the immune system to kill the cell.

CAR-T cell treatments for myeloma are designed to recognise specific proteins found on the surface of myeloma cells. One of the most commonly used targets is BCMA (B cell maturation antigen), because it is present in high levels on myeloma cells. By targeting BCMA the CAR-T cells can find and kill the myeloma cells more effectively. Researchers are also studying CAR-T cells that target other proteins that could offer additional options in the future.

What does CAR-T cell treatment involve?

There are a number of stages involved in having CAR-T cell treatment. This can take several weeks:

1. T cells are taken from the patient’s blood using a procedure called leukapheresis. Blood is drawn from a vein and passed through a machine to filter out immune cells, including T cells. The rest of the blood is returned to the patient. This can take two to three hours and may need to be repeated.
2. The collected T cells are taken to a laboratory and genetically modified, turning them into CAR-T cells. The CAR-T cells are then multiplied to create the right dose. This can take several weeks.
3. Whilst the CAR-T cells are being manufactured, patients are given treatment to keep the myeloma under control whilst waiting for the CAR-T cells to be returned, this is called “bridging treatment”.
4. Patients receive chemotherapy (cyclophosphamide and fludarabine) to prepare the body to receive the CAR-T cells.
5. CAR-T cells are put back into the patient’s bloodstream, through a drip. This takes a few hours.
6. CAR-T cells find and kill cancer cells in the body. Patients will be closely monitored for potential side effects.

Can CAR-T cell treatments cure myeloma?

Although the CAR-T treatments for myeloma can deliver longer remission times, they are not curative.

Results of clinical trials with CAR-T cell treatments for myeloma have so far been impressive, delivering good response rates and remission times for people who have relapsed and have treatment-resistant myeloma.

What are the side effects of CAR-T cell treatments?

Like other myeloma treatments, CAR-T cell treatments can cause side effects. The most common side effects of CAR-T cell treatments are:

• Low blood cell counts (cytopenia), which can cause increased risk of infections, bleeding or bruising and anaemia.
• Cytokine release syndrome (CRS), a potentially serious immune response which can cause symptoms like fever, shortness of breath and changes in blood pressure.
• Neurological side effects such as confusion or movement problems caused by immune effector cell-associated neurotoxicity syndrome (ICANS).

Some of these side effects can be potentially serious, but people receiving CAR-T cell treatments will be monitored frequently for early signs of side effects and given rapid care and supportive treatment if needed.

Are CAR-T cell treatments available in the UK?

There are currently two CAR-T cell treatments licenced for use in the UK, idecabtagene vicleucel (Abecma®, also called ide-cel) and ciltacabtagene autoleucel (Carvykti®, also called cilta-cel). Although, they have been licenced they have not been approved for use on the NHS in the UK.

However, there are two CAR-T cell treatments, ciltacabtagene autoleucel and anitocabtagene autoleucel (anito-cel), scheduled to go through appraisal by the National Institute of Health and Care Excellence (NICE) for use in England and Wales in 2026. Myeloma UK will be taking part in these appraisals and will be working hard to ensure people can access these treatments. We also hope to see the Scottish Medicines Consortium (SMC) engaging with appraisals of CAR-T cell treatments.

In Northern Ireland, the Department for Health makes decisions on which treatments to fund through the NHS. It can follow guidance issued by either NICE or the SMC but usually follows the guidance issued by NICE.

Please see our Myeloma Trial Finder for information on clinical trials currently investigating CAR-T cell treatments for myeloma.

If you have any further questions or need support, contact us through the Myeloma Infoline on 0800 980 3332 (UK) or by using the Ask the Nurse email service.

Further reading