CAR T-Cell Therapy for Cancer

Treatments that work by harnessing the power of the immune system are revolutionizing cancer care. NewYork-Presbyterian has become a certified treatment center for CAR T-cell therapy for adults (at NewYork-Presbyterian/Columbia University Irving Medical Center and at NewYork-Presbyterian/Weill Cornell Medical Center) with recurrent or persistent diffuse large B-cell lymphoma (DLBCL), a common type of non-Hodgkin lymphoma, and children and young adults (at NewYork-Presbyterian Morgan Stanley Children’s Hospital) with recurrent or persistent acute lymphoblastic leukemia (ALL). The expertise and skill of our CAR T-cell treatment teams, coupled with other specialists from all areas of medicine in one medical center, make NewYork-Presbyterian the ideal place to receive this potentially lifesaving treatment.

What Is CAR T-Cell Therapy?

CAR T-cell therapy is made from a patient's own white blood cells (T cells). CAR stands for "chimeric antigen receptor." The T cells are engineered to express these receptors, enabling them to recognize certain proteins on the surfaces of cancer cells. Here's how CAR T-cell therapy works:

• T cells are collected from the patient through a process called apheresis.
• The T cells are genetically modified in the laboratory to produce CARs. The CARs are specific to a protein studding the surface of each patient's cancer cells. For example, certain leukemia and lymphoma cells have the CD19 protein (antigen) on their surfaces, and there are CARs designed to recognize CD19.
• The modified T cells are multiplied in the lab to make hundreds of millions of them.
• The newly armed T cells are returned to the patient, where they set out to detect, attach to, and destroy cancer cells throughout the body.

Who Would Benefit from CAR T-Cell Therapy?

CAR T-cell therapy is used to treat select patients with leukemia and lymphoma. It is also under study in clinical trials for patients with other cancers. The U.S. Food and Drug Administration has approved CAR T-cell therapy to treat:

• Non-Hodgkin lymphoma in adults. Axicabtagene ciloleucel (Yescarta®) and tisagenlecleucel (Kymriah™) are used to treat adults with DLBCL that has continued to grow or came back despite at least two prior regimens of treatment. These therapies are available at both NewYork-Presbyterian/Weill Cornell and NewYork-Presbyterian/Columbia.
• Acute lymphoblastic leukemia in young patients. Tisagenlecleucel is used to treat children and young adults (age 25 and younger) with ALL that has continued to grow or came back despite at least two prior regimens of treatment. This therapy is available at NewYork-Presbyterian Morgan Stanley Children's Hospital and NewYork-Presbyterian/Columbia, and will be available for young adults at NewYork-Presbyterian/Weill Cornell.

CAR T-Cell Therapy at NewYork-Presbyterian

CAR T-cell therapy is one of several cellular therapies being developed at NewYork-Presbyterian. The cellular therapy programs at our hospital are part of our bone marrow and stem cell transplantation programs and build upon the many years of expertise we have in this area.

• Accredited programs. Our bone marrow and stem cell transplantation programs are accredited by the Foundation for the Accreditation of Cellular Therapy (FACT). Our care teams perform hundreds of stem cell transplants a year and translate this experience to the support of people undergoing CAR T-cell therapy.
• Exceptional resources. CAR T-cell therapy is given in our advanced, dedicated stem cell transplant units, offering individual monitoring and special airflow systems for patients with weakened immune systems. With a low nurse-to-patient ratio, you will get the essential quality care and ideal conditions needed for your recovery.

Every Expert You May Need

CAR T-cell therapy is a very intensive treatment, and complications may arise. The rapid ramping up of the immune system can cause fever, chills, confusion, low blood pressure, and other side effects that indicate the treatment is working, but which also require close monitoring and management. NewYork-Presbyterian has specialists and subspecialists from every area of medicine to care for people experiencing side effects of CAR T-cell therapy.

• A team of experts. In addition to a stellar team of stem cell transplantation physicians, nurses, and nurse practitioners with expertise in leukemia and lymphoma care, your team has access to infectious disease doctors, cardiologists, intensivists (intensive care unit physicians), and other doctors with the skills and expertise needed to promptly treat any complications that may arise.
• Experience means safety. Our CAR T-cell physicians have years of experience evaluating this treatment in clinical trials. They know how to give it safely and manage any side effects. They also have a great deal of experience caring for patients with multiple health problems and complex medical needs.
• Practical support. Most complications of CAR T-cell therapy occur within the first four weeks after receiving the treatment. If coming to NewYork-Presbyterian for treatment means traveling some distance from your home, we can assist you and your family with accommodations closer to the hospital to ensure you are near your treatment team during this critical period.

Expanding the Use of CAR T-Cell Therapy through Research

CAR T-cell therapy is a promising, highly innovative way to treat cancer, and doctors are understandably excited to see if it can help people with other types of cancer and other diseases. CAR T-cell and other cell therapies are under study in multiple clinical trials at NewYork-Presbyterian assessing their use for patients with other blood cancers as well as other cancers.

• NewYork-Presbyterian/Weill Cornell is one of two national sites evaluating an "off-the-shelf" CAR T-cell treatment (UCART123) for patients with acute myeloid leukemia (AML). This approach uses modified T cells from a "universal donor," rather than altering each patient's T cells individually.
• NewYork-Presbyterian/Weill Cornell investigators will soon begin a trial of a novel CAR T-cell product for patients with very advanced thyroid cancer.
• NewYork-Presbyterian/Columbia investigators are exploring cellular therapies for Epstein-Barr virus-related cancers and sickle cell disease.
• Our scientists are developing our own cellular therapies in a new onsite cell manufacturing facility at NewYork-Presbyterian/Columbia.
• Future clinical trials may include those evaluating CAR T-cell therapy in patients with multiple myeloma, chronic lymphocytic leukemia (CLL), and thyroid cancer.