UCLH is one of the few centres internationally to offer CAR-T cell therapy, for both NHS patients and for our private teenage and young adult patients. Professor Rachael Hough explains what CAR-T cell therapy is and how it works in treating patients with blood cancer.
T-cells are part of our natural immune system. They work in a targeted way, only attacking specific invaders in the human body, so are really important in very focused treatments for disease.
Different types of cancer have different proteins on the cell surface. CAR-T cell therapy is when we take T-cells from a patient and modify them to recognise the cells that carry the protein which is specific to their particular cancer. The modified T cells will then only seek out and destroy the cancer cells, leaving healthy cells alone.
CAR-T cell therapy has been one of the most significant advances in cancer treatment for many years as it allows us to successfully treat patients when other treatment options have failed. It has been particularly successful in patients with acute lymphoblastic leukaemia (ALL), although trials are taking place to develop treatments for other cancers in the future.
CAR-T cell therapy is like producing a living drug, which is made from the patient’s own cells.
Prior to the first stage of treatment, the patient will come in to hospital for a day for a process called leukapheresis –where existing T-cells are separated from the blood and harvested to be sent away for modification. The remainder of the blood is returned into circulation in the body. The removal process takes between four and six hours and there are very few side effects.
These T cells are then sent off to a drug manufacturer where they are modified to ensure they can accurately target the cancer cells. This part of the process takes around four to six weeks.
While the drugs are being modified, our patients will remain in hospital and be given a holding cycle of chemotherapy. This is a very gentle cycle of chemotherapy to keep the leukaemia controlled with as few side effects as possible whilst cells being manufactured. Patients will be monitored carefully throughout this time to check how well they are doing, and whether it is an appropriate time to be given the CAR-T cell therapy.
As patients are most at risk of infection at this time, it is vital that they remain in a highly specialised environment, where staff are experts in recognising the associated risks with this treatment. At UCLH we have a world-leading adolescent cancer centre, which has some of the best international expertise in treating leukaemia patients aged between 13 and 19 years old. All of our patients’ needs are catered for, including their psychological wellbeing, which is extremely high in our priorities.
When the patient’s modified cells are returned to UCLH, they will be put back into the body intravenously so that they can begin to destroy the cancer cells. Our team is experienced in managing any side effects from this stage in the process and our patients will be carefully monitored throughout their treatment in case any issues do arise.
CAR-T cell therapy can be successful in patients with acute lymphoblastic leukaemia where all other treatment options have failed, those who have had a relapse and are no longer responding to chemotherapy, or who have relapsed after a bone marrow transplant.
It may also be a suitable treatment option for patients who are likely candidates for a bone marrow transplant, but where a transplant would be difficult due to other health conditions.
At UCLH we established the first adolescent cancer service in the world in 1990, and have a long history of providing care tailored especially to the needs of teenage patients.
Our expert team of consultants (led by Dr Rachael Hough, specialist nurses and other allied health professionals, from occupational therapists to play specialists , all work together to create an holistic package of care, ensuring the physical and mental wellbeing of our patients is central to everything we do.
Our teenage cancer ward and social areas have been co-designed with our patients to make sure they create as much as a home from home as possible – with recreational facilities including chill out areas, creative spaces, gaming and WiFi options. Regular social activities, such as pizza night, bring a touch of normality to our teenagers at a difficult time. For our overseas patients we also offer an advocate service, with Arabic speaking team members available to help patients and their families navigate their stay in the UK.
