CAR T-cell Therapy for cancer treatment
Best hospitals and doctors for CAR T-cell therapy abroad
Leading hospitals
Cost for treatment
CAR T-cell therapy, or adoptive cell therapy, is one of the new directions in cancer treatment. CAR T-cell therapy allows acute forms of lymphoblastic and myeloid leukemia to be treated. Today CAR T-cell therapy is performed in a limited number of specialized clinics. The greatest experience in the treatment of patients with leukemia using CAR T-cell therapy has been accumulated in leading hospitals in Germany, Israel and the USA.
Content
- CAR T-cell therapy overview
- Diagnosis before the appointment of therapy car-t cell
- Treatment with CAR T-cell therapy
- Medical treatment of leukemia with CAR T-cell therapy
- Side effects of CAR T-cell therapy
- Where can I undergo CAR T-cell therapy abroad?
- The cost of treatment with CAR T-cell therapy
- How can I undergo CAR T-cell therapy abroad?
CAR T-cell therapy overview
CAR T-cell therapy is an innovative treatment for certain types of blood cancer, including leukemia. The patient's white blood cells are genetically programmed to destroy cancer cells. With the help of high-tech equipment, leukocytes (white blood cells, which are an important component of the immune system) are separated from the rest of the blood. In a specialized laboratory, the leukocytes undergo genetic modification to express chimeric antigen receptors (CAR). At the next stage, they are multiplied in laboratory conditions until there are millions of modified cells that are used for further cancer treatment.
The return of CAR T-cells to the patient's bloodstream is carried out by infusion. Now, chimeric antigen receptors will help genetically modified cells to bind to the corresponding antigens of cancer cells, effectively detecting and destroying them.
Antigens are substances that activate (turn on) the immune system. The immune system helps the body fight cancer. Antigens are located on the surface of all cells in the body. They are also found on the surface of elements that enter the body from the outside, such as bacteria and viruses.
The immune system uses T-cells to recognize which antigens do not belong to the body. T-cells have receptors with the help of which they bind to certain antigens. When a T-cell binds to an antigen, it sends messages to other cells in the immune system. These cells help to kill the atypical cells with the antigen on their surface and remove them from the body. CAR-T-cells are T-cells that have been genetically modified in the laboratory to bind to antigens on cancer cells. When a CAR T-cell binds to a cancer cell, the immune system sends immune cells to destroy the cancer cell and remove it from the body.
Diagnosis before the appointment of therapy car-t cell
Before the start of CAR T-cell therapy, patients undergo a comprehensive examination to assess the overall health condition. This will help to make sure the patient is ready for medical treatment. It also allows the CAR T-cell therapy team to predict the results of the treatment.
As part of the examination, the patient will need to complete some (perhaps not all) of the tests that are listed below.
Chest X-ray. It allows doctors to obtain information on the condition of the lungs are signs of cancer in them.
Blood tests. These are done to get the information on the kidney and liver function, blood cell counts, state of the immune system.
Analysis of urine. This is done to get the information on the kidney function and the state of the urinary tract.
Electrocardiogram (ECG) and echocardiogram. They provide the CAR T team with the information about the patient's heart condition.
Pulmonary function tests. These breath tests allow assessing lung function.
Computed tomography (CT). This radiologic examination provides more detailed information on the state of soft tissue and bone tissue compared to a standard radiological examination. In some cases, a CT scan is performed with contrast enhancement. In case of a mild allergic reaction, the use of a contrast agent is acceptable, but the patient must take medication before administering it, in order to avoid such a reaction.
Positron emission tomography (PET). This radiological test is done to study certain types of cancer, its location, and functional activity of inner organs.
Brain scan using magnetic resonance imaging (MRI). This is done to investigate the brain and its functioning.
Examination of the skeleton. This is done to get the information on bone tissue damage caused by cancer. Usually, patients with multiple myeloma have signs of bone damage. The procedure involves obtaining X-ray images of the large bones of the body.
Bone marrow biopsy. A bone marrow puncture includes harvesting a small sample of bone marrow from the pelvic bone. The pelvic bone is anesthetized, a needle is inserted into the marrow, and a small amount of the marrow is harvested.
CAR T-cell therapy includes modification of patient’s own T-cells so that they become able to attack and destroy cancer cells.
Children and adults with acute myeloid leukemia, acute lymphoblastic leukemia, and non-Hodgkin B-cell lymphoma are eligible to receive CAR T-cell therapy.
In Europe (large university hospitals in Germany), Israel, and the USA.
Blood cancer, including acute lymphoblastic and myeloid leukemia, non-Hodgkin B-cell lymphoma.
Prices for treatment are listed below:
| Disease | Cost in Germany | Cost in Israel |
| Acute lymphoblastic leukemia | from 436,190 € | from 81,970 € |
| Acute myeloid leukemia | from 436,190 € | from 81,970 € |
| Non-Hodgkin B-cell lymphoma | from 436,190 € | from 81,970 € |
Treatment with CAR T-cell therapy
CAR T-cell therapy is to some extent a hybrid method that combines the techniques of immunotherapy and genetic engineering.
In the immunotherapy part of CAR T-cell therapy, immunocompetent cells T-lymphocytes are extracted from the patient's peripheral blood. Being returned to the patient’s blood after the genetic modification, they activate antitumor immune mechanisms.
In the genetic engineering part of CAR T-cell therapy, T-cells are sent to the laboratory, where a new gene is added to them. This process is called a genetic modification. The new gene helps them find and destroy cancer cells. Once this new gene is added, the T-cells are called CAR T-cells.
When the CAR T-cells are ready, cancer patients receive low doses of chemotherapy. Chemotherapy is not given with the purpose of cancer cells being treated but helps to prepare the body for maximum efficiency of CAR T-cell therapy. When the body is ready, CAR T-cells are injected into the bloodstream.
CAR T-cell therapy is performed in hospitals, as it requires certain preparation and monitoring of the patient's condition after the procedure.
During the first visit, the cancer patient sees a doctor and other specialists from the CAR T-cell therapy team. The doctor will review the medical history, conduct a physical examination, and discuss the most appropriate medical treatment regimen. A doctor also discusses this plan with other CAR T-cell therapy doctors so that they can work together to agree on the best option for the medical treatment of cancer patients.
The patient will visit the blood donor office to see if the diameter of the veins allows collecting T-cells from a vein in the arm. If the veins are not wide enough, a special type of intravenous (IV) catheter designed for the leukapheresis procedure will be used to collect T-cells.
The blood donor office staff will tell the healthcare team if a cancer patient needs a leukapheresis catheter. If needed, the medical team will provide the patient with additional information.
The patient is supervised by a medical team throughout the whole duration of CAR T-cell therapy.
Medical treatment of leukemia with CAR T-cell therapy
Previously, CAR T-cell therapy in the treatment of leukemia was used only in the US hospitals. Today, the qualifications of specialists and the availability of a technical base allow applying the method in European hospitals.
The results of clinical trials and the application of this type of immunotherapy in medical treatment speak for themselves – in 70% of cases, it is possible to achieve positive dynamics of the cancer course or prolonged remission, which is equivalent to a cure. In the medical treatment of acute lymphoblastic leukemia, which mainly affects children from one to six years of age, success rates reach 80-90%, depending on the child's age and the stage of cancer.
Cancer treatment takes about a month. The actual procedure of CAR T-cell therapy resembles a blood transfusion. At the first stage, a comprehensive diagnostic examination is carried out to determine indications and possible contraindications for treatment. During the second stage, lymphocytes are separated from the patient's blood. Over the next two weeks, specialists artificially multiply cells in the laboratory and integrate chimeric receptors in them to fight leukemia and lymphoma.
At this time, the patient undergoes chemotherapy aimed at suppressing his own immunity. This will subsequently increase the activity of artificial cells and allow them to kill cancer cells more efficiently. The number of artificial cells is relatively low and amounts to 1 million per 1 kg of body weight. Once they enter the body, they continue to multiply and destroy malignant cells.
After the administration of cells with chimeric receptors, the patient stays in the clinic for another two weeks, under the supervision of specialists to assess the effectiveness of medical treatment and side effects. As a rule, possible side effects are similar to the symptoms of the flu and manifest themselves as chills, muscle pain, fever, migraines, and seizures.
Side effects of CAR T-cell therapy
The most common side effects of CAR T-cell therapy are:
- Flu-like symptoms: high fever, chills, low blood pressure, muscle or joint pain, shortness of breath, and quickening of the heartbeat
- Neurological disorders such as confusion, fatigue, seizures, restlessness, aphasia (impaired speech or understanding of speech), encephalopathy (impaired brain function)
- Anemia (low red blood cell count)
- Neutropenia (low leukocyte count in the blood)
The severity of these symptoms ranges from mild to severe one. Potential side effects of the procedure may require the administration of additional medications and prolongation of the hospital stay.
Where can I undergo CAR T-cell therapy abroad?
Health tourism is becoming more and more popular these days, as medicine abroad often ensures a much better quality of CAR T-cell therapy.
The following hospitals show the best success rates in CAR T-cell therapy:
- University Hospital Ulm, Germany
- University Hospital Freiburg, Germany
- Sheba Medical Center Ramat Gan, Israel
- University Hospital Frankfurt am Main, Germany
- University Hospital Heidelberg, Germany
You can find more information about the hospitals on the Booking Health website.
The cost of treatment with CAR T-cell therapy
The prices in hospitals listed on the Booking Health website are relatively low. With Booking Health, you can undergo CAR T-cell therapy at an affordable price.
The cost of treatment varies, as the price depends on the hospital, the specifics of the disease, and the complexity of its treatment.
The cost of treatment with CAR T-cell therapy in Germany starts from 556,000 EUR, depending on the diagnosis.
You might want to consider the cost of possible additional procedures and follow-up care. Therefore, the ultimate cost of treatment may differ from the initial price.
To make sure that the overall cost of treatment is suitable for you, contact us by leaving the request on the Booking Health website.
How can I undergo CAR T-cell therapy abroad?
It is not easy to self-organize any treatment abroad. It requires certain knowledge and expertise. Thus, it is safer, easier, and less stressful to use the services of a medical tourism agency.
As the largest and most transparent medical tourism agency in the world, Booking Health has up-to-date information about the CAR T-cell therapy in the best hospitals in the world. We will help you select the right clinic taking into account your wishes for treatment.
We want to help you and take on all the troubles. You can be free of unnecessary stress, while Booking Health takes care of all organizational issues regarding the treatment. Our services are aimed at undergoing CAR T-cell therapy safely and successfully.
Medical tourism can be easy! All you need to do is to leave a request on the Booking Health website, and our manager will contact you shortly.
Authors:
The article was edited by medical experts, board certified doctors Dr. Nadezhda Ivanisova and Dr. Sergey Pashchenko. For the treatment of the conditions referred to in the article, you must consult a doctor; the information in the article is not intended for self-medication!
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