Preparing for CAR T-cell therapy involves more than just the treatment itself. Myeloma expert Dr. Beth Faiman explains what patients and care partners can expect during the waiting period, reviews how bridging therapy helps control disease, and discusses why building a strong support system at home can make all the difference throughout the process.
Dr. Beth Faiman is an Adult Nurse Practitioner in the Department of Hematologic Oncology and Blood Disorders at the Cleveland Clinic. Learn more about Dr. Faiman.
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Transcript
Katherine Banwell:
You’ve mentioned the waiting period between cell collection and the infusion of CAR T cells. How should patients and care partners plan for this time?
Beth Faiman:
So, in general, when patients have myeloma, and they need CAR T-cell therapy, that means that their disease might not be well-controlled. So, in contrast to stem cell transplant when at the beginning we give four drugs induction at newly diagnosed, and then, after four to six months we have a planned stem cell transplant when that patient’s in remission, it’s different for CAR T because it means that they might have been relapsing from that prior therapy.
So, after we collect the CAR T cells, those T cells and make them into CARs, then we have what’s called a bridging therapy period. And that bridging therapy might be different depending on what the patient received before, what are their comorbid or other health illnesses, and what the goals of therapy are. Oftentimes, many centers are giving a drug called talquetamab-tgvs (Talvey), which is a bispecific antibody during that bridge because there have been studies that show that that might be effective, after they harvest the T cells, might be very effective to control the disease.
And the better disease control we have going into CAR T-cell therapy will hopefully cause less risk of CRS, less risk for bad outcomes.
And so, again, that will look a little bit different for each patient. But really, it’s a waiting period, and you kind of go about your business. Some people, I will say, though, want to take a vacation before their CAR T-cell therapy or a weekend trip, and that’s okay, too. But talk with your healthcare provider about what’s right for you and what you’d like to do, and hopefully they’ll be able to support you through that.
Katherine Banwell:
While the healthcare team is a key part of care, support at home is just as important. What does a strong home support system look like for someone undergoing CAR T?
Beth Faiman:
A strong home healthcare support system looks different for everybody.
Some people want to have a care partner or caregiver all the time, somebody that’s there. But other people are pretty independent. I’ve had the good fortune of meeting a number of patients that have gone through CAR T-cell therapy, and everybody has different desires. So, while you might not have a spouse or a significant other living under the same roof, you might find comfort in having somebody come regularly to visit you. The best thing you can do is find somebody or assemble a team of those care partners, caregivers, that are willing to be the eyes and the ears of the healthcare provider during the actual CAR T process time.
That’s within that 30 days from where you get your CAR T cells back to about 30 days after. And so, that can look different for everybody. But it might be bringing in meals from family and friends or it might be somebody that stays overnight to make sure that they’re safe. So, again, it looks different for everybody, but it’s just having a team of people that care about you and that you care about to help support you through that process.