CAR T-cell therapy is a type of immunotherapy used to treat multiple myeloma when other therapies have failed. It has improved remission and survival times, but long-term data on safety and success is limited.

Chimeric antigen receptor (CAR) T-cell therapy is a cell-based gene therapy. It’s also a form of immunotherapy because it helps the immune system find and attack cancer cells.

CAR T-cell therapy is used to treat blood cancers, including multiple myeloma.

This article discusses CAR T-cell therapy for multiple myeloma, how it works, and what you can expect during treatment.

T cells are a type of white blood cell that develop from stem cells in bone marrow. As part of the immune system, T cells help destroy abnormal cells and pathogens. In multiple myeloma, the T cells don’t recognize cancer cells as harmful.

The goal of CAR T-cell therapy is to correct that error.

In autologous CAR T-cell therapy, the treatment uses your own T cells. It starts with an intravenous (IV) blood draw. The blood runs through a machine that removes T cells, then returns the blood to you. This process, called leukapheresis, generally takes a few hoursTrusted Source.

In a laboratory, the T cells undergo genetic engineering to introduce CARs on the surface of the cells. CARs are proteins that help T cells see targeted tumor cells. Once that’s done, scientists grow more cells in the lab. This can take several weeks. In some cases, you may have to repeat this process.

When there are enough CAR T-cells for the procedure, they’re frozen and sent to your treatment center. Then they’re thawed and infused back into your body. The new cells, which can now recognize and attack cancer cells, continue to multiply.

The two CAR T-cell therapies approved for multiple myeloma are idecabtagene vicleucel (Abecma) and ciltacabtagene autoleucel (Carvytki).

Multiple myeloma can become resistant to drugs that were previously working, so the disease often progresses. CAR T-cell therapy is most likely to benefit those whose myeloma has recurred or has stopped responding to other treatments.

It’s not a first-line treatment for myeloma. It may be a treatment of last resort, but it has improvedTrusted Source remission and survival times. As with other treatments, the cancer can return even if CAR T-cell therapy works for a while. And some side effects are very serious.

An oncologist can review the benefits and risks so you can decide if it’s a good choice for you.

CAR T-cell therapy often causes a condition called cytokine release syndrome. This happens as the new T-cells stimulate the immune system, which produces an inflammatory response. Symptoms may include high fevers, dangerous fluctuations in blood pressure, and, in some cases, organ failure. The Washington University oncologists at Siteman are very good at treating cytokine release syndrome. They will use medications to reverse any symptoms that arise. Most patients who develop cytokine release syndrome make a full recovery.

Potential side effects of CAR T-cell therapy include:

• allergic reaction during infusion
• weakened immune system
• risk of infection
• low blood cell counts

As CAR T-cells boost the immune system, it can lead to something called cytokine release syndrome. This usually occurs within a few days to a few weeks. Symptoms may include:

• fever, chills
• breathing difficulties
• nausea, vomiting, diarrhea
• dizziness, lightheadedness
• headache
• rapid heart rate

The treatment can also affect the nervous system, causing side effects such as:

• headache
• confusion, agitation
• shaking, twitching
• seizures
• trouble speaking and understanding
• loss of balance
• changes in consciousness

ResearchTrusted Source suggests that CAR T-cell therapies are safe and effective for most people with recurrent or refractory multiple myeloma.

In a 2021 study, 73% of participants responded to treatment with Abecma, and 33% had a complete response, meaning there were no more signs of cancer. The median progression-free survival was 8.8 months overall.

In another small 2021 study, 97.9% of participants responded to Carvytki, and 80.4% achieved a complete response. The median duration of response was 21.8 months.

CAR T-cell therapy for multiple myeloma gained approval in 2017, so it’s still in its infancy. Data on efficacy and long-term safety are limited due to the short time frame and small numbers of trial participants. Researchers continue to follow those who have completed therapy in ongoing clinical trials.

The approach to treatment depends on factors such as:

• extent and characteristics of disease
• age and overall health
• previous treatments

Treatment options for multiple myeloma include:

• Chemotherapy: drugs that destroy fast-growing cells
• Targeted therapy: drugs that target specific characteristics of the cancer
• Stem cell (bone marrow) transplant: infusion with healthy stem cells after unhealthy ones are destroyed by high dose chemotherapy
• Radiation therapy: to shrink myeloma cells in a specific area
• Corticosteroids: to help fight myeloma cells and decrease inflammation

A doctor may offer supportive care for symptom management, and you may qualify to participate in a clinical trial.