Immunotherapy Program at Northside

Northside Hospital Cancer Institute, a nationally recognized treatment center for leukemia, lymphoma, myeloma, blood and marrow transplant, is now accepting patients for the first-ever FDA-approved CAR T cell therapy for adult patients with certain types of large B-cell lymphoma who have not responded to or who have relapsed after at least two other kinds of treatment.
The success of allogeneic stem cell transplantation, in which a donor’s bone marrow or blood is transplanted into a patient to cure aggressive blood cancers, primarily results from the power of a donor’s immune system to fight cancer cells. In fact, such transplants represented the first definitive proof of the human immune system’s capacity to cure cancer. Now, cancer researchers are developing new ways to strengthen and empower a patient’s own immune system, a revolutionary field called cancer immunotherapy.
Immunotherapy can be given in the form of drugs or as a cell-based therapy, which means that we extract and modify a patient’s own immune cells before infusing them back into the body. One of the most promising cell-based immunotherapy cancer treatments is CAR T cell therapy, chimeric antigen receptor T-cell therapy. The treatment involves:

  • Removing immune system T cells from the blood stream
  • Shipping T-cell product to a manufacturing laboratory
  • Genetically engineer (reprogram) T cells to produce special receptors on their surface called chimeric antigen receptors, or CARs. This enables the T cells to better recognize and kill cancer cells.
  • Expand T-cells to make billions of new enhanced T cells
  • Infuse CAR T cell product back to the patient to target and kill malignant cancer cells

Adult patients who have certain types of relapsed or refractory large B cell lymphomas who have received two or more types of treatment are eligible to receive CAR T cell therapy at Northside Hospital. Future FDA approved CAR T cell disease indications will become available soon. Current and future clinical research studies involving the use of CAR T cell therapy in leukemia, lymphoma and myeloma will be ongoing.

Why Refer/Choose Northside Hospital’s Immunotherapy Program?

The Blood and Marrow Transplant Group of Georgia physicians, experts in administering CAR T cell therapy and other immunotherapy cancer treatments, lead Northside Hospital’s Immunotherapy Program. The program has participated in novel CAR T cell therapy clinical trials and has the experience to care for patients who may develop mild to severe immunological side effects. With access to state-of-the-art diagnostic testing, facilities, comprehensive patient-centered care, and a highly trained team provide immunotherapy patients with exceptional quality care that result in outstanding survival outcomes and patient satisfaction.

Immunotherapy Patients Have Access To:

  • The Blood and Marrow Transplant Group of Georgia physician team have completed post-hematology/oncology fellowship training in hematopoietic stem cell transplantation and have vast experience administrating immunotherapy agents for hematological malignancies.
  • Interdisciplinary Team that includes a dedicated health psychologist, social worker, clinical BMT Pharm D.’s, nutritional services, physical therapy and chaplain services
  • State-of-the-Art facilities
  • Comprehensive quality management program
  • The Northside Hospital Blood and Marrow Transplant Program who has among the BEST BMT survival outcomes in United States
    • One of only two adult BMT programs in the country, and the only adult BMT Program in Georgia, to achieve survival outcomes that significantly exceeded the expected survival rate for allogeneic and unrelated donor transplants for the last 9 consecutive reporting cycles (2009-2017).1,2*
    • Only Core NCI BMT-CTN transplant center in the state of Georgia
  • NSH-Immunotherapy Program physicians will coordinate pre – post infusion care with your referring physician. Be assured treatment recommendations will be the most current and state-of-the-art.
  • Innovative clinical research trials so patients do not have to travel outside their community.
    • Participates in large national cooperative group clinical trials, collaborations with academic-university institutions, and the pharmaceutical industry
    • NCI- NCORP: Northside Hospital Cancer Institute and Lewis Cancer and Research Pavilion have collaborated with Georgia CORE to participate in NCORP. NCORP is a five-year NCI grant, which will provide cancer patients access to the latest NCI clinical trials in their local community.
  1. Reported outcome data from bethematch.org. This survival information includes only patients who received their first allogeneic transplant between January 1, 2013 and December 31, 2015 using unrelated or related donors, and who had reported follow-up.
  2. Final 2017 Transplant Center Specific Survival Report, December, 2017

How Does CAR T Cell Therapy Work?

Step One: Pre-CAR T cell testing
To determine if a patient is a CAR T cell therapy candidate, re-staging radiology studies, EKG/echocardiogram, bone marrow biopsy, blood work, and meetings with a BMTGA physician, clinical research nurse, and nurse care coordinator will occur. The BMTGA physician will review all test results and will determine if a patient is a candidate to receive CAR T cell therapy.

Step Two: T cell collection procedure
A central line catheter is placed in a large chest vein, connects to a blood collection machine, which removes T cells and then returns any remaining blood cells components collected back to the patient via the central line catheter. Leukopheresis/apheresis is a one-day outpatient procedure and performed at Atlanta Blood Services.

Step Three: Reprogram/Expansion/Manufacturing
Once T cell collection is completed, the T cell product is shipped to a CAR T cell-manufacturing laboratory.

  1. Reprogram: T cells are then genetically engineered to produce special receptors on their surface called chimeric antigen receptors, or CARs. This enables the T cells to better recognize, kill and destroy cancer cells.
  2. Expansion: The manufacturing laboratory grows and engineers CAR T cells until they number in the billions. Engineering and growing enough quantities of CAR T cells may take a few weeks to produce.
  3. Manufacturing: Once the target number of expanded/manufactured CAR T cells is achieved, the CAR T cells are then frozen and shipped back to the Northside Hospital Hematopoietic Stem Cell Laboratory.

Step Four: Chemotherapy
Prior to CAR T cell infusion, a patient receives disease-specific chemotherapy. Chemotherapy creates space within the immune system that allows the infused reprogrammed CAR T cells to grow and multiply.

Step Five: CAR T cell infusion
CAR T cell infusion occurs on the Northside Hospital Inpatient Blood and Marrow Transplant, Leukemia and Immunotherapy Unit. The infusion process is similar to receiving a blood product infusion. To prevent potential CAR T cell infusion reactions, pre-medications are given.

Step Six: Target and destroy
CAR T cells then multiple, and with guidance from their engineered receptors, are able to recognize and then kill cancer cells. During this period, if side effects develop, inpatient hospitalization may be required for several days or weeks.
Most common side effects are:

  • Fever (100.4°F/38°C or higher)
  • Difficulty breathing
  • Chills or shaking chills
  • Confusion
  • Dizziness or lightheadedness
  • Severe nausea, vomiting, or diarrhea
  • Fast or irregular heartbeat
  • Severe fatigue or weakness

Step Seven: Post CAR T cell recovery
Recovery from CAR T cell therapy can take two to three months. During this time, frequent clinic monitoring visits and possible hospitalization may occur.

Step Eight: Disease restaging follow up studies
At 100 days post CAR T cell infusion, and at additional time points, disease re-staging studies are performed at The Blood and Marrow Transplant Group of Georgia and Northside Hospital.