Recently Diagnosed or Relapsed? Stop Looking For a Miracle Cure, and Use Evidence-Based Therapies To Enhance Your Treatment and Prolong Your Remission
Multiple Myeloma an incurable disease, but I have spent the last 25 years in remission using a blend of conventional oncology and evidence-based nutrition, supplementation, and lifestyle therapies from peer-reviewed studies that your oncologist probably hasn't told you about.
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CAR-T Late Complications
I believe that the benefits of CAR-T therapy for MM patients outweigh the risks. However, CAR-T therapy does potentially have late complications that patients must be aware of. I congratulate Dr. Bishop for highlighting this difficult topic in the video below.
- “An underappreciated aspect is the long-term care that is necessary for patients with CAR-T cells.”
- “Compromised immune system…
- “extremely vulnerable to viral infections…”
- “late cytopenias…”
- “secondary cancers”
The question in my mind is whether it is possible to reduce any or all of the possible late CAR-T complications mentioned by Dr. Bishop?
Late Complications and Long-term Care of CAR T-cell Patients
I am a long-term MM survivor. I have relied on evidence-based non-conventional therapies to reduce my risk of long-term side effects such as secondary cancers. Full disclosure- I had an ASCT in ’95 but never had CAR-T therapy.
Listening to Dr. Bishop discuss the patient’s “compromised immune system” as a late CAR-T therapy complication, I immediately wonder about:
- nutrition
- supplementation and
- lifestyle therapies
shown to enhance immune systems. I wonder if MM patients who complete CAR-T therapy should then pursue these simple, yet effective, non-conventional therapies to enhance immune function. My usual reply to this question is…ask your oncologist.
Email me at David.PeopleBeatingCancer@gmail.com with your questions about managing your MM.
Hang in there,
David Emerson
- MM Survivor
- MM Cancer Coach
- Director PeopleBeatingCancer
Long-term outcomes following CAR T cell therapy: what we know so far
Abstract
Chimeric antigen receptors (CAR) are engineered fusion proteins designed to target T cells to antigens expressed on cancer cells. CAR T cells are now an established treatment for patients with relapsed and/or refractory
- B cell lymphomas,
- B cell acute lymphoblastic leukaemia
- and multiple myeloma.
At the time of this writing, over a decade of follow-up data are available from the initial patients who received CD19-targeted CAR T cells for B cell malignancies.
Data on the outcomes of patients who received B cell maturation antigen (BCMA)-targeted CAR T cells for multiple myeloma are more limited owing to the more recent development of these constructs.
In this Review, we summarize long-term follow-up data on efficacy and toxicities from patients treated with CAR T cells targeting CD19 or BCMA. Overall, the data demonstrate that CD19-targeted CAR T cells can induce prolonged remissions in patients with B cell malignancies, often with minimal long-term toxicities, and are probably curative for a subset of patients.
By contrast, remissions induced by BCMA-targeted CAR T cells are typically more short-lived but also generally have only limited long-term toxicities. We discuss factors associated with long-term remissions, including the depth of initial response, malignancy characteristics predictive of response, peak circulating CAR levels and the role of lymphodepleting chemotherapy.
We also discuss ongoing investigational strategies designed to improve the length of remission following CAR T cell therapy.
Key points
- Among haematological malignancies, the indications for use of chimeric antigen receptor (CAR) T cells are rapidly expanding. CD19-targeted CAR T cells are now approved for relapsed and/or refractory B cell lymphoma and B cell acute lymphoblastic leukaemia, and B cell maturation antigen-targeted CAR T cells are approved for relapsed and/or refractory multiple myeloma…
- B cell maturation antigen-targeted CAR T cells can induce prolonged remissions in patients with relapsed and/or refractory multiple myeloma, although whether any of these responses are curative remains unclear.
- Factors associated with durable remission after CAR T cell therapy include a deep initial response, lower baseline tumour volume, an absence of extramedullary disease, higher peak circulating CAR T cell levels and receipt of lymphodepleting chemotherapy.
- The most prominent long-term toxicities after CAR T cell therapy include cytopenias and hypogammaglobulinemia. The incidence of severe infections >1 month after CAR T cell therapy is low compared to infections seen in the acute period immediately after cell infusion.
- Ongoing research efforts are attempting to improve the durability of responses after CAR T cell therapy, for example, through improved patient selection, novel CAR designs, including those targeting multiple antigens, and modifications to the manufacturing process.