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CAR T-Cell Therapy

Genetically Engineered T-Cell Immunotherapy for Hematologic Malignancies

Written by: Saygı Hospital Health Guide Editorial Board
Last updated:

This content has been compiled by the Saygı Hospital Health Guide Editorial Board and is periodically reviewed by a specialist physician.

References (5)

This content is for informational purposes only and does not constitute medical advice. You can book an appointment at our Onkoloji department. Book Appointment →

What is CAR T-Cell Therapy?

CAR T-cell therapy uses autologous T lymphocytes engineered ex vivo with a chimeric antigen receptor (CAR) that combines an extracellular antigen-binding domain (commonly anti-CD19) with intracellular signaling domains (CD3-zeta plus 4-1BB or CD28).

Approved indications include relapsed/refractory B-cell acute lymphoblastic leukemia (tisagenlecleucel), large B-cell lymphoma (axicabtagene ciloleucel, lisocabtagene maraleucel), mantle cell lymphoma (brexucabtagene), follicular lymphoma, and multiple myeloma (idecabtagene vicleucel, ciltacabtagene autoleucel targeting BCMA).

The manufacturing process involves leukapheresis, viral transduction, in vitro expansion, lymphodepleting chemotherapy in the patient, and infusion.

Symptoms

Cytokine release syndrome (CRS): fever, hypotension, hypoxia, organ dysfunction within hours to days
Immune effector cell-associated neurotoxicity syndrome (ICANS): encephalopathy, aphasia, seizures
Prolonged cytopenias from lymphodepletion and on-target effects
B-cell aplasia and hypogammaglobulinemia (anti-CD19 products)
Hemophagocytic lymphohistiocytosis-like macrophage activation
Tumor lysis syndrome with high disease burden

Risk Factors

High tumor burden at infusion increases CRS severity
Pre-existing CNS disease elevates neurotoxicity risk
Active infection or organ dysfunction
Prior allogeneic transplant complications
High lactate dehydrogenase, thrombocytopenia
Older age and frailty (relative)

When to See a Doctor?

If you experience any of the following symptoms, seek medical attention promptly:

  • Fever, chills, or hypotension within 14 days of CAR T infusion (urgent)
  • Confusion, slurred speech, tremor, or new headache after CAR T
  • Persistent cytopenias or severe infection in CAR T recipient
  • Worsening dyspnea, oxygen desaturation post-infusion
  • Patient education on when to seek emergency care during outpatient monitoring

Treatment Methods

01
Lymphodepletion with fludarabine and cyclophosphamide before infusion
02
Tocilizumab (IL-6 receptor antagonist) for CRS grade 2 or higher
03
Corticosteroids (dexamethasone, methylprednisolone) for ICANS or refractory CRS
04
Anakinra (IL-1 receptor antagonist) for steroid-refractory neurotoxicity
05
Supportive care: vasopressors, oxygen, seizure prophylaxis
06
IVIG replacement for hypogammaglobulinemia
07
Long-term monitoring for relapse, secondary malignancies, and infections
08
Specialized REMS-certified centers required for administration

Which Department to Visit?

You can visit our Onkoloji department for these complaints. Our specialist physicians will create the most suitable treatment plan for you.

Learn About Onkoloji Department

Let us help you

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Health Disclaimer: The information on this page is prepared for general informational purposes only. It does not replace medical diagnosis and treatment. Please consult your physician for your complaints. Saygı Hospital does not accept responsibility for actions taken based on the information on this page.