What is chimeric antigen receptors T-cell therapy (CAR-T)?

CAR-T – chimeric antigen receptor T-cell – therapy is specifically developed for each individual patient and involves reprogramming the patient’s own immune system cells to manufacture a product which is used to target their cancer condition.

It is a highly complex and potentially risky innovative new treatment, but it has been shown in trials to cure some patients, even those with quite advanced cancers and where other available treatments have failed.

The interim service specifications for CAR-T therapy can be found at the following links:

• Axicabtagene ciloleucel chimeric antigen receptor T-cell (CAR-T) therapy for the treatment of adult patients with relapsed or refractory large B-cell lymphoma
• Tisagenlecleucel chimeric antigen receptor T-cell (CAR-T) therapy for ALL and diffuse large B-cell lymphoma (DLBCL)

Can you explain what the treatment involves?

The treatment involves several steps over a number of weeks.

First the patient’s blood is taken and is sent off to the manufacturer’s laboratory. Here the patient’s blood is ‘trained’ to fight the cancer cells.

The CAR-T blood is then transported back to the hospital and the patient is administered with the CAR-T to treat their condition.

What conditions can CAR-T cell therapy work for?

Currently, NICE has approved CAR-T use in the NHS for the following indications.

1. Relapsed or refractory B-Cell acute lymphoblastic leukaemia (ALL) in people up to the age of 25 years
2. Relapsed or refractory diffuse large B-cell lymphoma (DLBCL), primary mediastinal large B-cell lymphoma after 2 or more systemic therapies
3. Relapsed or refractory diffuse large B-cell lymphoma after first-line chemoimmunotherapy
4. Relapsed or refractory B-cell acute lymphoblastic leukaemia in people aged 26 years and over
5. Relapsed or refractory mantle cell lymphoma
6. Relapsed or refractory aggressive B-cell non-Hodgkin lymphoma

Who is eligible for the treatment?

The decision on which patients are eligible will be decided by a national panel of expert clinicians following a referral from a specialist doctor.

Please speak to your consultant about whether CAR-T is the right treatment and, if so, they can advise you on the referral route.

The treatment will be available to patients across the country.

Where is the treatment available and which centres will be providing the treatment?

NHS England has been working with The Joint Accreditation Committee ISCT-Europe and EBMT (JACIE) and the life sciences companies to get centres up and running.

The following centres will be able to provide CAR-T for paediatric patients:

1. Great Ormond Street Hospital
2. Newcastle University Hospitals NHS Trust
3. Manchester University Hospitals NHS Foundation Trust

The following centres will be able to provide CAR-T for young people up to the age of 25 years old and adults:

1. Barts Health NHS Trust
2. Cambridge University Hospitals NHS Foundation Trust
3. Imperial College Healthcare NHS Trust
4. King’s College Hospital
5. Leeds Teaching Hospitals NHS Trust
6. Manchester University Hospital NHS Trust
7. Newcastle University Hospitals NHS Foundation Trust
8. Nottingham University Hospitals NHS Trust
9. Oxford University Hospitals NHS Trust
10. Royal Marsden Hospital NHS Foundation Trust
11. Sheffield Teaching Hospital NHS Foundation Trust
12. St George’s University Hospitals NHS Foundation Trust
13. The Christie NHS Foundation Trust
14. The Clatterbridge Cancer Centre
15. University College London Hospital
16. University Hospitals of Leicester NHS Trust
17. University Hospitals Plymouth NHS Trust
18. University Hospital Southampton NHS Foundation Trust
19. University Hospitals Birmingham NHS Foundation Trust
20. University Hospitals Bristol and Weston NHS Trust