The Royal Marsden

Q&A: Cellular Therapy

Consultant Haematologist Dr Emma Nicholson explains how advances in immunotherapy using CAR-T cells are offering more treatment options for cancer patients
Consultant Haematologist Dr Emma Nicholson

Consultant Haematologist Dr Emma Nicholson


What is cellular therapy?

Cellular therapy is a type of immunotherapy treatment. The treatment requires the patient’s T cells – immune system cells – to be taken from the blood in a procedure called apheresis. A new receptor called a chimeric antigen receptor [CAR] is introduced into the T cells, which, following the infusion of the CAR-T cells back into the patient, binds to a protein on the cancer cells and kills them directly.

How can this be used to treat cancer?

The immune system has a key role in controlling the growth of tumours in the body. However, tumours have developed multiple mechanisms to escape and evade recognition by the immune system. T cells are important effector cells – activated cells that defend the body in an immune response – that are central in controlling tumour growth.

What are the side effects of CAR-T therapy?

The major side effect is cytokine release syndrome, which is a complication when a large number of immune cells are highly activated. It can be mild with fever and headaches, but can progress to blood flow instability, multiple organ failure and neurological toxicity.

Which patients can benefit from this treatment?

In the past year, we have been recruiting patients with relapsed or refractory diffuse large B-cell lymphoma [DLBCL] to a randomised clinical trial using CAR-T cells. The therapy has so far shown effectiveness in patients with multiply relapsed DLBCL who are resistant to standard chemotherapy and have limited treatment options. We are now treating patients with relapsed/refractory DLBCL at The Royal Marsden and hope to expand to other indications in the future.

What future research is going to be carried out into CAR-T treatment?

This is a very active area of research. At The Royal Marsden, we are opening a study using donor gamma delta T cells to treat relapsed or refractory acute myeloid leukaemia.