Carvykti and CAR T-cell therapy for multiple myeloma
Carvykti is a personalised cancer treatment that uses your body’s own immune system to fight multiple myeloma, a type of blood cancer. We modify specific immune cells, called T cells, to help recognise and destroy the cancer. Carvykti is primarily offered when multiple myeloma has returned or hasn’t responded to other types of treatment.
At London Haematology, our expert team of haematologists and specialists works with the latest advancements in cancer treatment, delivering dedicated care every step of the way.
What is Carvykti® CAR-T therapy?
CAR-T, or chimeric antigen receptor-T cell therapy is a new and advanced method of treating some forms of blood cancer. T-cells are a type of white blood cell, which form part of the immune system. They help us to detect and respond to infection and disease. CAR-T therapies work by collecting and then modifying one’s own T cells to attack their cancer through the recognition and targeting of specific protein receptors on the surface of their blood cancer cells.
Carvykti® (or ciltacabtagene autoleucel), is one such CAR-T therapy. It works by selectively targeting BCMA (B-cell maturation antigen), a protein found on the surface of B-cells. These are another type of white blood cell, which in later stages of development, include plasma cells. BCMA plays a role not only in the development of B cells, but their survival also. Multiple Myeloma (MM) is a blood cancer affecting plasma cells. We know that BCMA is found in significantly higher than normal levels on the surface of MM cells, and is therefore, an ideal target protein for treating MM. This form of targeted therapy not only destroys the cancer cells, but unlike conventional chemotherapy, limits toxicity to healthy cells, thus optimising outcomes for people with MM.
MM is referred to as a ‘relapsing and remitting’ blood cancer. It is common nowadays, due to vastly improved therapies and outcomes for people diagnosed with MM, to receive multiple drug therapies over many years. Carvykti® offers renewed potential for superior disease control when MM has not responded to other treatments (known as refractory disease) or has stopped responding (relapsed disease).
Is Carvykti® right for you?
At London Haematology, you are guaranteed a comprehensive consultation with an experienced CAR-T specialist who will consider your MM history and overall fitness before explaining the risks and benefits of the treatment for you as an individual. This discussion will ensure that you are empowered with the right information and understanding with which to make an informed decision. Together, we’ll decide if Carvykti® is the right treatment for you.
Proceeding to Carvykti® CAR-T therapy
Once you and your Consultant have agreed that treatment with Carvykti ® is the best option for you, the production and treatment process, usually takes approximately 2 to 3 months to complete. When first explained, CAR-T therapy can sound overwhelmingly complex, but at London Haematology, our expert team of Consultant Haemato-Oncologists (blood cancer consultants) and specialist multi-disciplinary team of nurses and allied health professionals are experienced providers of the very latest advancements in blood cancer treatments, including other CAR-T therapies. Care is delivered not only with clinical expertise, but with a person-centred focus. You can rest assured that we will support you at every step, including ‘keyworker’ support from our Clinical Nurse Specialists.
The Carvykti® process:
A blood giving line is placed in your arm, as is used for blood donors. Small volumes of blood are drawn into a machine called a cell separator which separates your white and red blood cells. Some of the white blood cells (including T cells), are collected and the rest of your blood is returned to you. This painless process is called leukapheresis, or in simple terms, a ‘cell collection’. This takes place in our ambulatory care unit, where our highly trained apheresis nurses will take 1:1 care of you. The collection takes an average of 4 hours and in a few cases may need to be repeated to gather enough cells.
Once collected, your white blood cells are frozen in our on-site Stem Cell Laboratory. They are then sent to a specialist manufacturing laboratory, where the T cells are selected and engineered into your custom-made Carvykti® CAR-T cells. This is done by genetically modifying your T-cells to recognize BCMA protein receptors on the surface of MM cells. Your modified T-cells are then sent back to The London Clinic, ready for you to receive as your personalised Carvykti® CAR-T treatment. This manufacturing and delivery process take an average of 30 days.
You will be admitted to our specialist stem cell transplant unit to receive, low dose ‘conditioning chemotherapy’. This will condition (prepare), your immune system by reducing the number and suppressing the function of your white blood cells. This helps create optimal conditions and available bone marrow capacity to receive Carvykti®. Conditioning chemotherapy is administered on the three consecutive days prior to receiving your Carvykti®.
A couple of days after completing your last dose of conditioning chemotherapy, you’ll receive your Carvykti®. Our specialist nurses will deliver this as a single intravenous infusion that takes approximately 30 to 60 minutes. You will receive 1:1 nursing care at this time as you may experience an early or delayed reaction such as fever or chills. Your CAR-T cells continually divide and multiply in your system. This ensures that you have a steady stream of cells capable of recognising and destroying Myeloma cells over time.
You will remain an inpatient for approximately 2-3 weeks, during which time we will continue to closely monitor for signs or symptoms of anticipated immune reactions to the treatment called CRS (Cytokine Release Syndrome) or ICANS (immune effector cell associated neurotoxicity syndrome). These can range from mild to severe and again, are fully discussed when considering treatment. On occasion, we may recommend enhanced support in our excellent intensive care unit, to optimise your safety until your immune response settles.
On discharge, we ask you to stay within one hour of The London Clinic for at least a month. This optimises your safety by enabling us to monitor your treatment response and to readmit you promptly should any serious delayed effects occur.
It’s important to attend regular check-ups so we can closely monitor the results of your treatment and respond quickly if you require any additional care at any stage.
Frequently asked questions (FAQs)
It can take several weeks for you to see the results of your Carvykti treatment. Some patients notice improvement within a few weeks, while for others, it may take longer.
We’ll closely monitor you during your recovery and for around four weeks after your treatment. This helps us understand how well your body is responding and ensures you receive the right support as you recover.
From collecting your blood sample to receiving your Carvykti infusion and beginning recovery, you can expect the process to take at least eight weeks.
However, recovery times can vary from person to person. We’ll provide you with a personalised timeline based on your individual needs.
Unlike traditional treatments like chemotherapy, Carvykti uses your T cells – part of your own immune system – to target and destroy myeloma cells in the body.
Like many cancer treatments, Carvykti can cause side effects. Some are common and usually temporary, while others can be more serious and require close monitoring.
Common side effects of Carvykti may include:
- Feeling very tired
- Nausea
- Headaches
- Fever
- Decreased appetite
Less common but more serious side effects can include:
- Infections – because Carvykti can weaken your immune system, you may be at higher risk of infections becoming more serious than usual
- Low blood counts – a decrease in white blood cells, red blood cells and platelets can lead to tiredness, bleeding and an increased risk of infection
- Neurological symptoms – some people may experience confusion, difficulty speaking, memory changes or seizures
- Heart problems – in rare cases, Carvykti can affect the heart, causing irregular heart rhythms (arrhythmia) or reduced heart function
- Cytokine release syndrome (CRS) – a potentially life-threatening immune reaction that can cause symptoms such as a fever, low blood pressure, difficulty breathing and, in severe cases, organ damage
Although there is a risk of serious side effects with Carvykti, we take every precaution to ensure your safety. You’ll be closely monitored during and after your treatment to detect any early signs of complications. If any issues or serious side effects arise, we’ll act quickly to treat them without delay in our well-equipped intensive therapy unit (ITU).