Preparing for CAR T-cell therapy can be overwhelming—and knowing the right questions to ask can make all the difference. Myeloma specialist Dr. Krina Patel reviews important questions for care partners to ask during appointments and offers advice for preventing infections and staying organized through every step of the process.
Dr. Krina Patel is an Associate Professor in the Department of Lymphoma/Myeloma at The University of Texas MD Anderson Cancer Center in Houston, Texas. Dr. Patel is actively involved in research and provides care for patients with multiple myeloma. Click here to learn more about Dr. Patel.
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Transcript
Katherine Banwell:
When a loved one is considering CAR T-cell therapy, what sorts of questions should care partners be asking during the consultation?
Dr. Krina Patel:
Yeah, this is a fantastic question. So, in myeloma and other diseases, we know that patients who have less myeloma going into the cell therapy piece of it truly have better outcomes, meaning that they have less toxicity from the CARs, and they have better efficacy. And again, if you think about it, these T cells are alive.
It’s like a war inside your body, so, if there’s more of the good guys, the T cells, and less of the enemy, the myeloma, those T cells don’t have to work as hard to kill.
And every time a T cell kills a myeloma cell, there’s a lot of inflammation that happens. So, if there’s less myeloma, we know that those patients are going to do better. So, the biggest questions to ask your doctor are, “When my partner is going through this, how will they knock that myeloma down?” That bridging therapy is so important. The other big thing I would say is, once patients are coming back for CAR T, we have to make sure they don’t have infections.
So, are there special precautions you have to take during that bridging therapy? Should they get IVIG to kind of help prevent infections? How long should they be off the treatment before you actually come back for the CAR T therapy, and then afterwards, it really is going to be, it’s a great therapy, but the first few months, there’s a lot of supportive care.
And so, making sure that there’s a checklist usually that we give our patients to say, “These are the therapies you need in addition to the CAR T,” and really having that calendar, maybe, ready to go so that you know what they’re supposed to do once you go home. We’re always available if you need, but again, it’s just the organization of the different types of supportive care you need from, again, from the apheresis, when the cells are collected, to the bridging therapy, and then through the CAR T process.
Katherine Banwell:
Once someone has decided to undergo CAR T, what advice do you have for preparing for the CAR T-cell therapy process, and how can a care partner be helpful during this time?
Dr. Krina Patel:
Yeah, so, I would say that, again, for most patients, after you’ve had apheresis, you’re probably going to have one to two months before you actually come back for the CAR T therapy. And during that time, again, it’s really important that we are giving you treatment to make sure your myeloma comes down or stays controlled, if it already is at low levels. So, making sure you’re taking your treatments.
And then, if you have infections. So, the biggest thing that can happen is if someone gets an infection during that time, we really want to make sure that’s treated before they come back for their CAR T. So, let us know, let your primary oncologist know if you’re somewhere else before coming back for the CAR T. I think the other piece is if you’re having side effects, if something’s going on, even with the bridging therapy, because most of the time, we use something different that patients haven’t had before, and so if there are issues, letting us know right away so that we can adjust things.
Because, again, our biggest concern is that when you get to CAR T, we want to make sure you’re doing well as well as your counts, and making sure you don’t have infections so that you can have the best outcome after. This is also the time I tell my patients who might have, you know, extra pain from their myeloma, our goal really is to control all of that before you come back. We want the CAR T to cause the least issues possible, so, that’s our time period to try to help.
Tell people to eat a heart healthy diet, staying hydrated, walking, learning how to stay focused, and especially if you’re moving to another city, figuring out ways to make sure, like you’re coming to Houston, Houston traffic can cause craziness for some people. So, just mentally preparing, right? That this is going to be a few weeks, but really, just getting your whole body ready for this. And I think the care partner is a person who can keep people in check.
I will say, the care partner also has to mentally prepare and be ready as well, just as important as our patients. But again, this is sort of where you get to be that life coach for that patient to kind of get them through until they come back to us for the CAR T.