CAR T-Cell Therapy: Empowering Pediatric Cancer Treatment

• Harnessing the immune system: CAR T-cell therapy empowers the immune system to target and eliminate cancer cells, offering a new approach to pediatric cancer treatment.
• Successful outcomes: Samitivej Children's Hospital has achieved remarkable success with CAR T-cell therapy, treating 10 patients, including 7 pediatric cancer patients, and delivering exceptional care and outcomes.
• State-of-the-art facilities: Samitivej Children's Hospital is equipped with advanced facilities, supporting the delivery of CAR T-cell therapy at the forefront of medical innovation. 

Chimeric antigen receptor (CAR) T-cell therapy is an advanced form of immunotherapy that shows great promise in combating blood cancer. By modifying a patient's T cells and reintroducing them into the body, CAR-T cell therapy empowers the immune system to identify and attack cancer cells, offering hope for children with leukemia, and potential avenues for clinical trials to treat other cancer types.

T Cells

T cells are special white blood cells that help our body fight infections and diseases such as cancer. They move around in our body to find and destroy bad cells. When we get sick, T cells are produced to fight the specific problem. They also remember the infections they fight, so if we get sick again they can quickly attack and stop it.

CAR T-cell therapy is an innovative cancer treatment that enhances the ability of T cells to recognize and eliminate cancer cells. It involves genetically modifying T cells in a laboratory to express chimeric antigen receptors (CARs), which improve their targeting capabilities. This therapy addresses the challenge of distinguishing cancer cells from normal cells, offering a promising approach to cancer treatment.
 

CAR T-cell therapy works by genetically engineering T cells to produce CARs, which are receptors capable of recognizing specific proteins on cancer cells. T cells are collected from a parent or sibling and modified in a lab to express CARs, enabling them to bind to specific proteins on cancer cells. These modified CAR T-cells are then multiplied and infused into the patient's bloodstream.

CAR T-cell therapies are customized to target specific cancer antigens. For example, in certain types of leukemia and lymphoma, the cancer cells have an antigen called CD19. CAR T-cell therapies are designed to bind to the CD19 antigen, but they are not effective for cancers that do not have this antigen.

Once in the body, the CAR T-cells can recognize and target cancer cells more effectively. They initiate a powerful immune response, leading to the destruction of cancer cells. This personalized approach harnesses the patient's immune system to fight cancer, providing a targeted and potent treatment option. CAR T-cell therapy has demonstrated significant efficacy, especially in cases where other treatments have been unsuccessful. It has received USA FDA approval for the treatment of hematological malignancies like leukemia, lymphoma, and multiple myeloma, offering hope to patients facing these diseases.

• Collecting the T Cells: The blood of a parent or sibling is drawn from a vein and undergoes a process called apheresis, also known as leukapheresis, to remove T cells, which takes about 2-3 hours, while the remaining blood is returned to the body.
• Engineering the T Cells: T cells are sent to a laboratory where they are genetically modified by adding a manufactured CAR, allowing them to become CAR T cells. These cells are then multiplied in the lab approximately 3-4 weeks.
• Preparing for CAR T Cells: 1 - 2 weeks before CAR T-cell therapy, low-dose chemotherapy is given to prepare the patient’s body and optimize the effectiveness of the treatment. This helps create space for the new CAR T cells by reducing the number of other immune cells, enhancing their ability to fight cancer.
• CAR T cells are infused into the patient's arm after an adequate quantity is produced. Hospitalization for 3-4 weeks is required to closely monitor the patient's condition during this time. 

CAR T-cell therapy is indicated for some children who have relapsed, or to target refractory (R/R) blood cancers such as acute lymphoblastic leukemia (ALL), Large B cell non-Hodgkin's Lymphoma, and solid tumors like neuroblastoma, when conventional treatments have been unsuccessful.

To determine if you qualify for CAR T-cell therapy, consult a pediatric oncologist who will assess your medical condition. Factors like cancer type, stage, previous treatments, and overall health will be considered. Seek expert advice and personalized guidance by scheduling an appointment. 

• Cytokine release syndrome (CRS) is a serious complication characterized by fever, chills, muscle pain, nausea, and low blood pressure
• Nervous system problems can occur, leading to headaches, confusion, seizures, and difficulty speaking or balancing
• Other potential serious side effects include abnormal blood mineral levels, allergic reactions, a weakened immune system, and low blood cell counts

Experienced doctors and nursing teams specialized in CAR T-cell treatment can promptly recognize and treat symptoms. Close monitoring and adherence to a standard of care are crucial during CAR T-cell therapy to address potential serious side effects.

• Expertise: Led by Prof. Suradej Hongeng, M.D., our specialized team has extensive experience in CAR T-cell therapy, stem cell transplantation, and cancer treatment. With over 1,000 pediatric oncology patients and successful CAR T-Cell treatments for 10 patients, including 7 pediatric cancer patients, we deliver exceptional care and outcomes.
  Research Contributions: Prof. Suradej Hongeng's groundbreaking work in CAR T-cell therapy, including the development of CD19 Chimeric Antigen Receptor (CAR) modified T-cells, has revolutionized the field. Learn more about his CAR T-cell therapy research here: https://onlinelibrary.wiley.com/doi/epdf/10.1111/ajco.13474. Explore other research articles by Prof. Hongeng here: https://pubmed.ncbi.nlm.nih.gov/?term=Hongeng+S&cauthor_id=36427475.
• CAR T-cell Manufacturing Facility: Our partnership with Thailand's First GMP-certified for Cell and Gene Therapy manufacturing facility ensures international standards and advanced technology for CAR-T production. Patient safety is prioritized with rigorous quality testing. Our collaboration for top-quality CAR T-cell therapy is trusted, and cost-efficient by 5-fold compared to outsourcing abroad.
• Multidisciplinary Team: Our team consists of various specialists, including Pediatric Hematologists and Oncologists, Pediatric Pulmonologists, Pediatric Cardiologists, Pediatric Psychiatrists, Pediatric Dentists, Dietitians, Pharmacists, Ward Nurses, Lab and Blood Bank Unit Technicians, Infection Control Nurses and more, who collaborate closely to provide comprehensive and coordinated care to children undergoing CAR T-cell therapy.
• State-of-the-Art Facilities: Samitivej Children's Hospital is equipped with advanced facilities including private rooms, all of which have HEPA filters with positive pressure ventilation, supporting the delivery of CAR T-cell therapy at the forefront of medical innovation.
• International Standard of Care: Samitivej Children's Hospital has been awarded the prestigious "Specialty Hospital of the Year" at the 2022 Healthcare Asia Awards. This accolade is a testament to our commitment to providing international standard care to patients across Asia. Our hospital strives for excellence in delivering exceptional healthcare services, ensuring the highest level of quality and safety for our patients.