UPMC Video Rounds - CAR T-cell Therapy

July 24, 2020


Randy Windreich, MD, Clinical Director of the Division of Blood and Marrow Transplantation and Cellular Therapies at UPMC Children's Hospital of Pittsburgh:

CAR T-cell research is a type of immunotherapy that we use in patients with either precursor B-cell, acute lymphoblastic leukemia, or in the adult population, large B-cell lymphomas.

Since CAR T-cell is immune therapy we need to collect the patient's immune cells, in this case the T-lymphocytes, from the patient to then genetically and modify them to target the patient's own leukemia cells, so we collect them through a simple apheresis procedure, which usually takes a couple of hours. We then send the cells to the lab where they get genetically modified with the insertion of a special kind of receptor called a CAR or chimeric antigen receptor.

That process allows the T-cells to then recognize B-cells, in this case the patient's own leukemia, B-cell leukemia, which then cause an activation of those T-cells to attack and kill more of their leukemia cells.

We bring the patient back in from home, we administer several days of chemotherapy to just essentially weaken the immune system or lympho deplete them, and then a couple of days later we will infuse the CAR T-cells

Since CAR T-cell uses the patient's own immune system we're able to avoid the toxicities of chemotherapy and radiation therapy that these patients would normally be receiving as part of their treatment plan.

I think as we learn more about CAR T-cell, as we study CAR T-cell even more than we have, we're hoping to try to adapt this to other types of cancers, not just the B-cell leukemias, but hopefully, eventually, T-cell leukemias, myeloid leukemia, and lymphomas as well as solid tumors.

I think the way we approach CAR T-cell Therapy at the Children's Hospital of Pittsburgh is similar to how we approach care at the Children's Hospital of Pittsburgh. Really with a family centered approach. The medical team, the nursing staff, the sub specialists, we all worked very to, cohesively, very together to really create and bring that best care, safest care possible to our patient population.

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