Redefining Cancer Care

Introducing Kerala’s First CAR T-Cell Therapy for Blood Cancer Patients

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Overview

Amrita Hospital, Kochi, announces its pioneering initiative to become the first hospital in Kerala to offer CAR T-cell (Chimeric antigen receptor) therapy for cancer care. This breakthrough treatment is set to revolutionize the management of aggressive blood cancers by leveraging gene-modified cell therapies.  CAR-T cell therapy enables us to harness the power of our immune system to target cancer cells with precision, offering new hope to patients with previously untreatable conditions. CAR-T cell therapy represents a groundbreaking approach in cancer treatment, with the potential to provide long-term remission and care for certain types of blood cancers. The process involves genetically modifying a patient's own T cells in the laboratory to equip them with chimeric antigen receptors (CARs) that enable them to recognize and destroy cancer cells. These modified T cells are then reintroduced into the patient's body, where they continue to combat cancer cells, offering a promising avenue for treatment.  To ensure widespread availability of this life-saving therapy, Amrita Hospital has partnered with ImmunoACT, an IIT Bombay incubated company.  The therapy cost in India is about one-tenth compared to outside countries. Amrita Hospital in Kochi is actively working on research and innovation to further enhance affordability and effectiveness. 

Patient Care Pathway for CAR T Cell Therapy

  • Referral to AIMS

    • Patient gets referred to AIMS for CAR T cell therapy.

  • Initial Consultation

    • Patient is seen by the designated consultant.
    • Consultant checks indications for CAR T cell therapy (NexCAR19):
    • Relapsed/Refractory B cell malignancy.
    • CD19 positivity (demonstrated via flow cytometry or tissue biopsy).
    • Absence of CD19 negative cancer cells.
    • Consultant counsels the patient about CAR T cell therapy.

  • Detailed Counselling

    • Patient meets with the CAR T cell therapy coordinator.
    • Coordinator provides detailed information about the procedure, cost, and required hospital stay.

  • Decision Making and Booking

    • Patient and family decide to proceed with CAR T cell therapy.
    • Designated consultant fills out the Google form for NexCAR19.
    • CAR T coordinator confirms slot availability with ImmunoACT.

  • Cost Discussion and Advance Payment

    • Coordinator directs the patient to the FIC counter for cost explanation.
    • Patient makes a 75% advance payment to book the slot.

  • Medical Work-Up

    • Parallel medical work-up begins post-payment
    • Blood tests (pre-op serology).
    • Imaging (if required).
    • Bone marrow test (if required).
    • PET scan (if required).
    • Salvage chemotherapy (as decided by the consultant).
    • Video consent taken by the designated consultant.

  • Apheresis Preparation

    • Venous access consultation provided for blood bank apheresis.
    • Department coordinator arranges admission for CAR T apheresis if necessary.

  • Logistics and Apheresis

    • CAR T coordinator arranges logistics transport with ImmunoACT.
    • Pre-CD3 and lymphocyte counts checked one day before apheresis.
    • Pre-CBC done on the day of apheresis.
    • Apheresis product handed over to logistics partner with verified checklist.

  • Product Verification

    • ImmunoACT receives and verifies the product.
    • Coordinator receives communication of acceptance and informs patient and consultant.

  • Bridging Chemotherapy

    • Consultant decides on the need for bridging chemotherapy.

  • Product Readiness

    • ImmunoACT informs when the product is ready.

  • Conditioning Chemotherapy

    • Coordinator arranges patient admission for conditioning chemotherapy.
    • Admission on Day -6.
    • Conditioning chemotherapy administered on Days -5, -4, and -3.
    • Two days of rest follow.

  • CAR T Cell Product Infusion

    • On Day 0, CAR T cell product will be received.
    • Designated doctor and coordinator check quality parameters, temperature log, and dose.
    • Conditioning chemotherapy administered on Days -5, -4, and -3.
    • Product thawed in a 37°C water bath and infused with appropriate precautions.

  • Post-Infusion Observation

    • Patient observed as an inpatient for 10 days to monitor for toxicity.
    • Resident in charge monitors the patient twice daily and updates the consultant.
    • Medicines administered for CRS and ICANS if necessary.

  • Post-Discharge Care

    • Patient advised to stay near the hospital post-discharge.
    • Regular OPD visits two to three times a week for follow-up with the consultant.

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