Understanding CAR T-Cell Therapy Side Effects
- Patients should know that while CAR T-Cell Therapy can cause side effects, doctors have a proven toolkit to monitor, manage, and often prevent them from becoming serious.
- For a detailed explainer on how CAR T-Cell Therapy works to re-engineer a patient’s own T-Cells to become cancer fighting warriors, read more here.
“CAR T-cell therapy patients have some degree of side effects, but we do grade them depending on the degree of severity. Most of the side effects we see these days are what we call grade one and grade two, which are easily manageable symptoms, and there are good guidelines to address symptoms and good medications,” Dr. Sai Pingali, a medical oncologist and hematologist at Houston Methodist in Texas, tells SurvivorNet.
Read MoreWhy Car T-Cell Therapy Side Effects Happen
CAR T-cell side effects happen because the treatment creates a very powerful immune response—which is the same reason it works so well against cancer. When CAR T-cells are re-engineered and put back into the body, they rapidly multiply and begin attacking cancer cells. In the process, they trigger immune reactions that can spill over and affect healthy tissues. The two most common side effects are:Cytokine Release Syndrome (CRS)
As CAR T-cells kill cancer, they release cytokines—chemical signals that call other immune cells into battle. When this response becomes too strong, the body experiences systemic inflammation, which can cause fever, low blood pressure, and breathing problems. In short: CRS happens because the immune system becomes hyper-activated.
Clinical trials of commercially available CAR T-cell therapies showed a median time of CRS onset of 2 to 3 days with a median duration of 7 to 8 days.
“The first symptom that typically happens is fever,” Dr. Pingali explains. “Some patients may need just some oxygen supplementation in addition or IV fluids, and some patients may need more than that in terms of needing more aggressive ventilation, which will be a higher flow of oxygen requirements and also requiring blood pressure supporting medication.”
WATCH: Cytokine Release Syndrome: A CAR T-Cell Therapy Side Effect
The Toolkit For Managing CRS
Doctors are very familiar with this reaction and treat it quickly. Medications like tocilizumab (which calms the overactive immune response) and steroids can usually bring symptoms under control within hours to days. Most patients recover fully.
“That decision on which product we use is determined based on the age and frailty of the patients, and we tailor our CAR T-cell product options to a particular patient,” Dr. Pingali says. “Again, there are more options for our patients, particularly Breyanzi approval for more indications has helped more patients who would not have been typically candidates for other kinds of CAR T-cell therapy products because of their frailty or concern for the side effects.”
Expert Resources on CAR T-Cell Therapy
Neurologic or “Brain-Related” Effects
Another side effect that can happen after CAR T therapy affects the brain and nerves. Doctors call this ICANS, which stands for immune cell-associated neurotoxicity syndrome.
You might have confusion, trouble finding words, trouble writing, headaches, tremors, or feel very sleepy. In rare cases, patients can have seizures.
The Playbook For Handling Neurologic Effects
These symptoms are watched for very carefully, especially in the first two weeks after infusion. If they happen, doctors treat them with medications like steroids and supportive care. Most people return to normal within a few days.
WATCH: What To Expect When Preparing For CAR T-Cell Therapy
Why Many Patients Still Choose CAR T-Cell Therapy
Even with these risks, CAR T therapy can be life-changing. Studies show that for some people with aggressive or recurring blood cancers, CAR T can make the cancer shrink or disappear in 60 to 80 percent of cases — even when other treatments no longer worked.
Despite these side effects, the key is that doctors expect them and know how to respond quickly. That’s why CAR T-Cell Therapy is only given in specialized hospitals with trained teams and 24-hour monitoring.
In these centers, patients are carefully observed for at least one to two weeks after treatment, and follow-up continues for months afterward. Most patients who experience side effects recover completely.
“The goal from medical standpoint is to control the side effects and control the chain reaction but without compromising the anti-cancer activity which we want to get from the CAR T cell therapies,” Dr. Pingali adds.
Questions To Ask Your Doctor
- Am I a candidate for CAR T-cell therapy?
- What are my chances of remission or cure with this new therapy?
- Where would I need to go for treatment?
- How will I be monitored before, during, and after treatment?
- What happens if I get side effects?
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