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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?

CAR T-cell therapy starts with a process called leukapheresis. During leukapheresis, immune cells called T cells are taken from your blood. 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 your 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. At the lab, the T cells 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, you’ll get chemotherapy for a few days to help prepare your body for the treatment. Then the CAR T cells are infused back into your blood, where they can seek out the cancer cells and help your immune system attack them.

CAR T-cell treatments for multiple myeloma

There are two CAR T-cell therapies that target the BCMA protein, which is found on myeloma cells.

• Idecabtagene vicleucel (ide-cel, Abecma)
• Ciltacabtagene autoleucel (cilta-cel, Carvykti)

Either of these treatments can be used in people who have already received other types of medicines to treat their multiple myeloma.

Possible side effects of CAR T-cell treatments

CAR T-cell 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

CAR T-cell 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.

Infections

CAR T-cell therapy can increase your risk of infection. Your cancer care team may recommend medicines to help prevent or treat possible infections even before you have any symptoms.

Other serious side effects

Other possible serious side effects can include:

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

Your cancer care team will watch you closely for several weeks after you get the CAR T cells. It’s very important to tell them about any side effects 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.