Understanding CAR T-Cell Therapy for Blood Cancers: Q&A with Dr. Navneet Majhail

September is Blood Cancer Awareness Month, a time to honor and raise awareness for the 1.6 million people currently living with or in remission from blood cancers in the United States. According to bone marrow donor registry, Be The Match, every 3-4 minutes someone in the United States is diagnosed with a blood cancer like leukemia, myeloma, or lymphoma. Be The Match partners with HCA Healthcare’s Sarah Cannon Cancer Institute to make a positive impact on blood cancer patients and research, and has provided $2.5 million in support grants that have helped nearly 900 patients since 2011.

Navneet Majhail, MD, MS, FASTCT is a board-certified hematologist and physician-in-chief of blood cancers at the Sarah Cannon Transplant and Cellular Therapy Network (SCTCTN), who specializes in blood and marrow transplant and cellular therapy for adults with blood cancers. This month, we asked Dr. Majhail to explain his work at HCA Healthcare and Sarah Cannon Cancer Institute, and the value of CAR T-Cell Therapy as an important blood cancer treatment.

What is the Sarah Cannon Transplant and Cellular Therapy Network?

SCTCTN is a network of 10 programs with 1,200 colleagues across the HCA Healthcare ecosystem, with seven locations in the U.S. and three in the UK that provide care to patients with complex blood cancers such as leukemia, patients receiving blood and marrow transplant and cellular therapy, and patients receiving gene therapy for blood diseases. In 2022, we cared for more than 1,000 acute leukemia patients and 1,600 transplant and cell therapy recipients. Our scale makes us the largest provider of complex blood cancer care in the U.S., but what sets us apart is our one comprehensive network approach to patient care.

Our physicians and teams work together to standardize patient care pathways, treatment regimens, quality plans and processes so that every patient receives the same high-quality care at all of our programs. Another highlight for the SCTCTN is the opportunity to integrate cutting-edge research with care for blood cancer patients through our partnership with the Sarah Cannon Research Institute. This collaboration ranges from first-in-human research studies to clinical trials that lead to FDA approval of blood cancer drugs.

What is CAR T-Cell therapy?

Chimeric antigen receptor T-cell therapy, also known as CAR T-cell therapy, is a novel immunotherapy that programs a patient’s immune system to recognize and fight cancer. The immune system is responsible for ridding the body of abnormal cells that are foreign (like cancer) or infected. T-lymphocytes (T-cells) are a type of cell responsible for killing abnormal cells.

During the CAR T-cell treatment process, T-cells are drawn from a patient’s blood and genetically engineered to recognize the patient’s cancer cells when reinfused. T-cells are really good at killing cancer cells, but under normal circumstances need the help of other immune cells to work effectively. With the technology we have available now, these cells can be taken from the body and their DNA modified such that they can start identifying cancer proteins and antigens directly.

What diseases are treated with CAR T-cell therapy? What types of patients are good candidates?

The FDA has approved CAR T-cell therapies for patients with advanced acute lymphoblastic leukemia, lymphoma, and multiple myeloma. However, since T-cells can be engineered to target any cancer antigen, there is a significant amount of research underway to evaluate treatment for other blood cancers and in patients with solid tumors (e.g. GI cancers, brain tumors, lung cancer, etc.).

In addition, we are now able to genetically modify other types of immune cells to treat cancers. Most importantly, we are able to offer these cutting-edge treatments in clinical trials to cancer patients at SCTCTN. In fact, our programs participated in many clinical trials that ultimately led to FDA approval for nearly all CAR T-cell treatments currently approved for routine clinical use. 

How does the process work?

Patients first undergo testing to ensure they qualify for the CAR T-cell procedure. The patient’s T-cells are then collected through an apheresis machine which filters out lymphocyte cells, which are sent off for manufacturing. Once ready, they are shipped back to us. Patients then receive chemotherapy to suppress their immune system, and the CAR T-cells are subsequently given as intravenous infusions. Patients are observed very closely for 4-6 weeks after the infusion to monitor for and manage any complications.

Are there any side effects associated with the therapy? Talk to us about the role of a CAR T-cell remote patient monitoring program to extend continuity of care.

CAR T-cells can sometimes cause a state of inflammation early after they are infused into patients, and two resultant life-threatening side effects we encounter are “cytokine release syndrome” as well as a syndrome of neurological toxicity that can range from confusion to seizures. Most hospitals in the country typically admit and keep patients in the hospital for 1-2 weeks to monitor these toxicities. However, we have a highly innovative program that we’ve implemented across our SCTCTN programs where patients can remain in the outpatient setting by using a remote patient monitoring platform.

Patients use a wearable device that provides data on temperature, oxygenation levels, heart rate and blood pressure to nurses and are monitored 24/7. This allows us to keep patients out of the hospital, and quickly bring them in and treat them if we see early evidence of side effects. This centralized monitoring across the network is something that has only been implemented by HCA Healthcare and is a great example of the multidisciplinary care that our hospitals and care teams provide.

CAR T-cells is one of many examples where our Sarah Cannon Cancer Institute and other HCA Healthcare colleagues combine compassionate care with cutting-edge research in caring for patients with blood cancers. I am fortunate and grateful to be a member of such an incredible team.

To learn more about CAR T-Cell therapy, visit Sarah Cannon’s website.