The Adult Bone Marrow Transplant and Cellular Therapy (BMTCT) Unit at the Bristol Haematology and Oncology Centre (BHOC) is the regional referral centre for stem cell transplants, serving a population of 6.5 million. It is the only hospital in the Southwest offering CAR T cell therapy, a groundbreaking treatment for certain types of lymphoma and leukaemia. UHBW became an adult CAR-T treatment centre in 2018 and continues to lead in this field within the region.

What Are CAR-T Cells?

CAR-T cell therapy is a type of treatment that uses cells from your own immune system to fight specific types of lymphoma or leukaemia. There are trials looking at the use of CAR T cells in treating myeloma.

T cells, or T lymphocytes, are a type of white blood cell. As well as killing germs, T cells can recognise and kill any of your own cells that have become abnormal (such as cancer cells). However, cancer cells are good at tricking your T cells, either by looking very similar to healthy cells or by sending signals that tell your T cells not to attack them.

CAR T cells are made by collecting T cells from the patient and re-engineering them in the laboratory to produce proteins on their surface called chimeric antigen receptors, or CARs. The CARs recognize and bind to specific proteins, or antigens, on the surface of cancer cells.

After the revamped T cells are “expanded” into the millions in the laboratory, they’re then infused, like a blood transfusion, back into the patient. When they stick to the lymphoma cells the CAR-T cells are activated and kill the cancerous cells. If all goes as planned, the CAR T cells will continue to multiply in the patient's body and, with guidance from their engineered receptor, recognize and kill any cancer cells that harbour the target antigen on their surfaces.

Who Can Receive CAR-T Cells?

CAR-T cell therapy is designed for specific types of lymphoma or leukaemia that have relapsed (returned) or are refractory (have not responded to other treatments). Due to its intensity, patients need to be physically fit to undergo the therapy.

You may be eligible for CAR-T cell therapy if you are:

A child or adult with relapsed or refractory B-cell acute lymphoblastic leukaemia (ALL).

An adult with relapsed or refractory:

Diffuse large B-cell lymphoma (DLBCL),
Primary mediastinal large B-cell lymphoma (PMBL) after at least two prior treatments,
Mantle cell lymphoma after at least two prior treatments, provided your previous therapy included a BTK-inhibitor like ibrutinib.

The primary side effects of CAR-T cell therapy are cytokine release syndrome (CRS) and immune effector cell-associated neurotoxicity syndrome (ICANS).

Ambulatory Care in Stem Cell Transplant and CAR-T Cells

In order to facilitate the new treatments available, an ambulatory care pathway for patients' post-transplant and for those undergoing melphalan autografts for myeloma and CAR T cell lymphodepletion was developed. This pathway allows patients to receive treatment outside of the traditional inpatient setting, to receive post-transplant care at the near hospital accommodation and for the transplant team to support patients' ongoing recovery while reducing hospital stays.

How the Friends of BHOC Have Supported the BMT Service

In 2022, the BMT team at UHBW approached the Friends of BHOC to fund an additional Advanced Clinical Practitioner (ACP) to enhance the ambulatory care service. This allows patients undergoing CAR T or stem cell transplant treatments to receive part of their care as outpatients, enabling them to return home each day.

This initiative aligned with the NHS Long Term Plan (2019), which advocates for the expansion of ambulatory care to accommodate new treatments like cell and gene therapies, as well as the Five Year Forward View (2016), which emphasizes improving cancer care and patient experiences. Research has shown that ambulatory care helps improve patient well-being, reduces hospital-acquired infections, and allows patients to sleep, eat, and exercise better outside of hospital settings.

The ACP funded by the Friends of BHOC provides expert care for patients undergoing CAR T and stem cell treatment, managing their care in the ambulatory care unit and offering post-discharge support both in outpatient clinics and at the nearby hospital-funded accommodation. The Friends of BHOC ACP-funded role has also included the development of a post-transplant women's health clinic and provides education for healthcare professionals at various levels.

The main beneficiaries of this funded post have been the patients, who have received more personalised care focused on their needs and preferences and allowing the expansion of the ambulatory care service within the BMT and CAR T cell service.

Thank you to Rebecca Hallam, Advanced Clinical Practitioner in BMT and IEC, for writing this blog and thank you to our readers for taking the time to read this blog and learn more about where some of the funds we raise go to and the impact they have on the patients and staff at the Bristol Oncology Centre.

Advancing Cancer Care: BHOC’s Leadership in CAR-T Therapy