What’s next for CAR-T?

Back in 2019 we reported how King’s College Hospital had become the first site in the UK to use the newly approved CAR-T (chimeric antigen receptor T-cell) therapy to treat adult patients with lymphoma. 

Since then, King’s Health Partners Haematology has become one of the largest CAR T centres in Europe - offering autologous (transplants from the same person who will receive the transplant) and allogeneic (transplants from a person other than the patient) CAR-T therapy to patients with Lymphoma, B-ALL and myeloma. 

We caught up with Dr Robin Sanderson - Consultant Haematologist at King’s College Hospital NHS Foundation Trust, and Honorary Senior Lecturer at King’s College London – to get the latest on this work. 

Please can you introduce your role at King’s Health Partners? 

I was appointed from academia when I was completing my PhD investigating CAR-T cells in an experimental mouse model in chronic lymphocytic leukemia (CLL). I had a lot of experience in the academic side of CAR-T and the challenges of manufacture of CAR-T cells in the lab, but my role was really to lead a large service expansion of CAR-T therapy with the then recent approval of licensed CAR-T in high-grade lymphoma particularly.  

I must stress there are many Consultant colleagues who were already and continue to be involved in the programme here, given King’s College Hospital NHS Foundation Trust had very early UK experience of CAR-T with the phase 1 CAR-T trial under Dr Benjamin. Alongside my CAR-T role I am the apheresis collection facility medical director, so I have oversight over a lot of the quality processes in relation to apheresis and CAR-T and our CAR-T reporting requirements for The Joint Accreditation Committee ISCT-Europe & EBMT (JACIE). As lymphoma is my specialist disease interest I manage all stages of lymphoma management from diagnosis to highly relapsed/refractory patients and am especially interested in CAR-T trials in this therapy space.  

What is CAR-T therapy? 

CAR stands for chimeric antigen receptor, which is a specific type of receptor (binder) which can be inserted into a specific type of immune cell call T cells to help them kill cancer cells.  

The T cells are collected from the patient on an apheresis machine, usually we use patients own cells to make the eventual product but there are trials using other types of donated cells. The cells are genetically manipulated to insert the CAR, typically using a virus but there are newer ways of doing this being trialled.  

The end product is a bag of immune cells which have been genetically manipulated ready to be infused into a patient with cells which should target and hopefully eradicate their cancer completely. 

What have been the results? 

Ultimately we have demonstrated that this type of therapy cures some patients with certain types of chemotherapy refractory lymphoma and leukaemia. It does not work for everyone and it brings great logistical and financial challenges. However, as a principle that genetically modified immune cells can cure cancer is truly amazing.  

One of the main roles of our department now is to expand the use of CAR-T therapy, by using both existing products for new indications (rarer types of lymphoma or in earlier lines of treatment for example), and new types of CAR-T cells in diseases which don’t currently have a CAR-T option through the investigation of new CAR-T targets and using novel cells.   

How has working in partnership helped staff and patients? 

Delivering CAR-T has always been a huge team effort from the clinicians, excellent nursing care to manage the quite specific complications of CAR-T, stem cell lab, apheresis, pharmacy and involvement from multiple other medical specialties to support us particularly intensive care and neurology as this is a new type of medical therapy and we are still learning so much about it. 

What’s next for this work? 

Broadening access to CAR-T for the indications in which there is already a license through education and improvement in our clinical pathways. Bringing CAR-T further forwards in treatment lines in diseases which already have a CAR-T option and as a centre being involved with clinical trials of CAR-T with novel targets, using novel cells particularly in diseases which don’t currently have a licensed CAR-T option. 

King’s Health Partners Haematology brings together our strengths in clinical service, research, and education to deliver exceptional outcomes for haematology patients