Cellular Immunotherapy
What if the cells that cancer affects could be trained to fight back? This is the core of cellular immunotherapy at Fred Hutchinson Cancer Center. Cells are taken from your body and multiplied in a lab. Sometimes they are also re-engineered to help the cells better fight cancer. The boosted cells are then returned to your body. Now they are better able to spot cancer cells that were once hidden and attack them. Our treatments include chimeric antigen receptor (CAR) T cells, T-cell receptor (TCR) modified cells and tumor infiltrating lymphocyte (TIL) cell therapy.
David G. Maloney, MD, PhD and Medical Director of the Bezos Family Immunotherapy Clinic talks about CAR T-cell therapy at Fred Hutch.
Car T-Cell Therapy
CAR T-cell therapy is a game changer in the field of cellular immunotherapy. This innovative therapy engineers a patient’s own T cells to zero in on enemy cancer cells. The rebooted T cells can even help the immune system “remember” these cancer cells, which may offer long-lasting protection against cancer returning — even after the treatment is completed.
How CAR T-Cell Therapy Works
Collecting T Cells
CAR T-cell therapy begins with the collection of the patient’s T cells, a type of white blood cell.
Training the Cells
The cells are engineered to become cancer-fighting cells, called chimeric antigen receptor (CAR) T cells.
Multiplying CAR T Cells
The CAR T cells are grown in the lab until there are millions to infuse back into the patient.
CAR T Cells Fighting
Once infused into the patient, the CAR T cells are now able to recognize and destroy cancer cells.
Cellular Immunotherapy Research Therapies
In addition to offering FDA-approved therapies, Fred Hutch also partners closely with the Fred Hutchinson Cancer Research Center to offer cellular immunotherapy clinical trials to individuals with different diseases. These clinical trials may include Chimeric antigen receptor (CAR) T-cell therapy, T-cell receptor (TCR) therapy or Tumor Infiltrating Lymphocyte (TIL) therapy.
Chimeric Antigen Receptor (CAR) T Cell
CAR T-cell therapy is where your T cells are modified in the lab so that they make a type of protein known as CAR before they are grown and given back to you. CAR stands for chimeric antigen receptor. CARs are designed to allow the T cells to attach to specific proteins on the surface of the cancer cells, improving their ability to attack the cancer cells.
T-Cell Receptor (TCR)
TCR is similar to CAR T-cell therapy, but instead of attaching to specific proteins on the surface of the cancer cells, TCRs can recognize tumor specific proteins on the inside of the cells.
Tumor Infiltrating Lymphocytes (TIL)
Tumor Infiltrating Lymphocytes (TIL) are T cells that can be found in your tumor. During TIL therapy, TILs are collected or “harvested” from your tumor and treated with substances that make them grow to large numbers quickly. The cells are given to you and used to target and kill cancer cells.
Fred Hutch Offers FDA-Approved Cellular Immunotherapies
The FDA has approved six cellular immunotherapies for patients with hematologic malignancies. These are:
- Tisagenlecleucel, known by the brand name Kymriah®, is available for adults with relapsed or refractory large B-cell lymphoma and relapsed or refractory follicular lymphoma. It is also available for young adults with relapsed or refractory acute lymphoblastic leukemia.
- Axicabtagene ciloleucel (axi-cel), known by the brand name Yescarta®, is available for adults with relapsed or refractory large B-cell lymphoma, as well as relapsed or refractory follicular lymphoma.
- Brexucabtagene autoleucel, known by the brand name Tecartus®, is available for adults with relapsed or refractory mantle cell lymphoma (MCL) and adults with relapsed or refractory B-cell precursor acute lymphoblastic leukemia (ALL).
- Lisocabtagene maraleucel, known by the brand name of Breyanzi®, is approved to treat adults with relapsed or refractory large B-cell lymphoma.
- Idecabtagene vicleucel, known by the brand name of Abecma®, is approved to treat adults with relapsed or refractory multiple myeloma.
- Ciltacabtagene autoleucel, known by the brand name of Carvykti™, is approved to treat adults with relapsed or refractory multiple myeloma.
Fred Hutch is one of the first centers in the nation to offer all six, due to the extensive experience of our physicians and nurses in developing and delivering this complex, groundbreaking therapy.
Frequently Asked Questions
These CAR T-cell therapies are FDA approved therapies available only at authorized treatment centers such as Fred Hutch. This type of immunotherapy uses engineered T cells to harness the power of a patient’s own immune system to treat certain types of non-Hodgkin lymphoma (NHL), such as LBCL and MCL, and acute lymphoblastic leukemia (ALL), as well as multiple myeloma.
These CAR T-cell therapies are different from other cancer medicines because they are made from the patient’s own white blood cells, which have been modified to recognize and attack the patient’s cancer cells.
Axicabtagene ciloleucel (axi-cel), also known by the brand name Yescarta®, is an FDA-approved treatment for aggressive non-Hodgkin lymphoma (NHL).
This therapy is available at Fred Hutch for:
- Adult patients with confirmed diagnosis of diffuse large B-cell lymphoma (DLBCL), primary mediastinal B-cell lymphoma (PMBCL), high-grade B-cell lymphoma, or DLBCL arising from follicular lymphoma that has either not responded to, or has relapsed after two or more lines of systemic therapy. Therapy must have included a CD20 antibody and an anthracycline.
- Adult patients with relapsed or refractory follicular lymphoma (FL) after two or more lines of systemic therapy.
- Adult patients with large B-cell lymphoma that are unresponsive to first-line chemoimmunotherapy or that relapse within 12 months of first-line chemoimmunotherapy.
- Patients must have adequate organ, cardiac and pulmonary function (must meet established criteria/measures).
Tisagenlecleucel, also known by the brand name Kymriah®, is an FDA-approved treatment for individuals with acute lymphoblastic leukemia (ALL) and aggressive non-Hodgkin lymphoma (NHL).
This therapy is available at Fred Hutch for:
- Young adults (ages 18–25) whose B-cell acute lymphoblastic leukemia (ALL) is refractory or in second or later relapse.
- Adult patients with relapsed or refractory large B-cell lymphoma, including diffuse large B-cell lymphoma (DLBCL) not otherwise specified, high grade B-cell lymphoma or DLBCL arising from follicular lymphoma that has either not responded to, or relapsed after, second or greater lines of systemic therapy.
- Patients must have adequate organ, cardiac and pulmonary function (must meet established criteria/measures).
Brexucabtagene autoleucel, also known by the brand name Tecartus™, is an FDA-approved treatment for adults with relapsed or refractory mantle cell lymphoma (MCL) and adults with relapsed or refractory B-cell precursor acute lymphoblastic leukemia (ALL).
This therapy is available at Fred Hutch for:
- Adult patients with relapsed or refractory mantle cell lymphoma.
- Patients must have adequate organ, cardiac and pulmonary function (must meet established criteria/measures).
Lisocabtagene maraleucel, also known by the brand name Breyanzi®, is an FDA-approved treatment for adults with relapsed or refractory large B-cell lymphoma ( LBCL).
This therapy is available at Fred Hutch for:
- Adult patients with relapsed or refractory large B-cell lymphoma after two or more lines of systemic therapy including diffuse large B-cell lymphoma not otherwise specified (including DLBCL arising from indolent lymphoma), high-grade B-cell lymphoma, primary mediastinal large B-cell lymphoma and follicular lymphoma grade 3B.
- Patients must have adequate organ, cardiac and pulmonary function (must meet established criteria/measures).
Idecabtagene vicleucel, also known by the brand name Abecma®, is an FDA-approved treatment for adults with multiple myeloma.
This therapy is available at Fred Hutch for:
- Adult patients with multiple myeloma who have received four or more prior lines of therapy, including an immunomodulatory agent, a proteasome inhibitor, and an anti-CD38 monoclonal antibody.
- Patients must have adequate organ, cardiac and pulmonary function (must meet established criteria/measures).
Ciltacabtagene autoleucel, also known by the brand name Carvykti™, is an FDA-approved treatment for adults with multiple myeloma.
This therapy is available at Fred Hutch for:
- Adult patients with relapsed or refractory multiple myeloma who have received four or more prior lines of therapy, including an immunomodulatory agent, a proteasome inhibitor, and an anti-CD38 monoclonal antibody.
- Patients must have adequate organ, cardiac and pulmonary function (must meet established criteria/measures).
- Because CAR T-cell therapy is made from the patient’s own white blood cells, blood will be collected by a process called “leukapheresis” (LOO-kuh-feh-REE-sis), which concentrates white blood cells.
- The patient’s blood cells are then sent to a manufacturing center to make the treatment.
- Before getting CAR T-cell therapy, the patient will usually have several days of chemotherapy to help the T-cells grow.
- When CAR T-cell therapy is ready, the patient’s care team will infuse the cells through a catheter placed into a vein (intravenous infusion). The infusion usually takes less than 30 minutes.
- The patient is then monitored daily for at least seven days after the infusion.
- Patients should plan to stay close to Fred Hutch for at least four weeks after getting treated. Our care team will help with any side effects that may occur.
- If patients have side effects, they may be hospitalized until their condition is stable and it is safe to leave the hospital.
- Patients should not drive for eight weeks following T-cell therapy.
These therapies are available for a certain population of cancer patients. However, patients at Fred Hutch also have access to many different therapies, including other CAR T-cell therapies in clinical trials. Talk with our care team to learn more.
Right now, the FDA has approved CAR T-cell therapy for adult patients with certain types of lymphoma, acute lymphoblastic leukemia, and multiple myeloma that hasn’t responded to other forms of treatment. Clinical trials of different CAR T-cell therapies for a variety of cancers are underway at Fred Hutch, as we are pioneers in this new form of cancer treatment.
Health insurers are preparing their coverage policies for these new FDA-approved treatments. In the meantime, coverage will be reviewed on a case-by-case basis, which is typical when new therapies are first approved. At Fred Hutch, we will do everything we can to seek health insurance coverage for clinically eligible patients.
Bezos Family Immunotherapy Clinic
Fred Hutch is a global CAR T-cell therapy leader, home to groundbreaking science and advanced immunotherapy. Over 200 patients have been part of our CAR T-cell clinical trials — one of the largest groups for a single institution. As both a research and cancer care center, we provide the therapies of tomorrow, today.
This expertise is the foundation for our Bezos Family Immunotherapy Clinic. Opened in October 2016, it is the first of its kind: a center dedicated to cellular immunotherapy, where Fred Hutch can offer more clinical trials and the newest therapies. Our specialized patient care coordinators at the Bezos Family Immunotherapy Clinic at Fred Hutch can provide more information.
In addition to the Bezos Family Immunotherapy Clinic, cellular immunotherapy patients can also be seen in the Blood and Marrow Transplant Program by immunotherapy experts.
Contact the clinic specialized patient care coordinator at 866.268.6129.
Learn more about the Bezos Family Immunotherapy Clinic.
Long-Term Follow-Up
If you received immunotherapy treatment from Fred Hutch and have questions related to your treatment that your local physician can’t answer, our Long-Term Follow-Up (LTFU) program is here to help. Our physicians will work with you and your local team to care for you. We will also gather information from you to help us prevent and treat any long-term effects of immunotherapy.