Immunotherapy, including CAR T-cell therapy, travels through the bloodstream to help prompt what is called an “immune response.” Because immunotherapy can affect healthy cells as well as cancer cells, certain side effects may be experienced, including digestive tract symptoms, loss of appetite, fatigue and flu-like symptoms. (See the “General Side Effects” section of this booklet for tips on managing these potential side effects.)
Report any side effects that you experience to your health care team right away so they can help you manage them. The side effects can range in severity; reporting them early can minimize their intensity and seriousness. It’s important to remember that not all people experience all side effects, and people may experience side effects not listed here.
CAR T-cell therapy has its own specific potential side effects, including:
- Cytokine-Release Syndrome (CRS). The infusion of CAR T-cells into the body results in the production of large numbers of cytokines (molecules that help cells communicate), which can cause the immune system to become excessively active. This can lead to CRS, with symptoms such as high fever and flu-like symptoms. These side effects can be controlled and reversed with cytokine-blocking drugs and steroids.
- B-Cell Aplasia. The FDA-approved CAR T-cell therapy products destroy normal as well as cancerous B-cells, which can cause B-cell aplasia (low numbers of B-cells), in which the body is less able to make the antibodies that protect against infection. Immunoglobulin replacement, administered intravenously, can be used to treat or prevent infection.
- Tumor Lysis Syndrome (TLS). When cancer cells break down (are destroyed) very quickly, they release large amounts of potassium, phosphate and uric acid into the blood. This can result in TLS, a group of conditions that can cause neurological, heart or kidney problems. TLS is managed by medicines that decrease potassium and uric acid levels in the blood. Medicines may also be prescribed that help increase urination.
- Changes in Cognition. Some changes in cognition (thought processes) ranging from mild to severe can occur within several days of CAR T-cell therapy. The symptoms are often treated with steroids and are almost always reversible.
Because of these possible side effects, people who have undergone CAR T-cell therapy should stay close to their treatment location for at least four weeks, so they can be closely monitored by their healthcare team.
Side Effects of Chemotherapy
People being treated with CAR T-cell therapy receive a low dose of chemotherapy, which gives the CAR T-cells a better chance to fight the cancer. Because of this, certain side effects may be experienced, including:
- Hair loss
- Increased risk of infection (from having too few white blood cells)
- Easy bruising or bleeding
- Changes in memory or thinking
- Peripheral neuropathy (numbness or tingling in hands and feet)