What is Chimeric Antigen Receptor T-cell Therapy and why is Tennessee Valley Healthcare System at the Forefront? 

Since 2019, VA Tennessee Valley Healthcare System has offered Chimeric Antigen Receptor T-cell Therapy, also known as CAR T-cell therapy, to Veterans across the country with more than 57 procedures performed.  

CAR T-cell therapy is a type of immunotherapy used to treat certain types of blood cancers like lymphoma and leukemia. This therapy allows the immune system to target and attack cancer cells.  

“[CAR T-cell therapy] is actually one of the most cutting-edge therapies that we have for patients who have certain types of lymphomas and leukemias, and it has been FDA approved for some years now,” said Dr. Salyka Sengsayadeth, TVHS medical director of stem cell transplant and cellular therapy.  

Patients who are referred for consideration for CAR-T cell therapy undergo extensive evaluation to determine their suitability for this intensive treatment.  

The first step in CAR T-cell therapy is the collection of T-cells, known as immune cells. After collecting the patient’s immune cells through apheresis, the cells are re-engineered to target lymphoma or leukemia cells. Once the T-cells are programmed to find the cancer cells, the patient will receive a type of chemotherapy called lymphodepletion, and then the T-cells can be infused into the blood, according to Sengsayadeth. 

CAR T-cell therapy has shown promising results in the treatment of certain blood cancers. At TVHS, CAR T-cell therapy data is consistent with data from clinical trials, according to reports in the scientific journals Nature Medicine and Transplantation and Cellular Therapy.   

Presented at the Association of VA Hematology Oncology conference in September 2023 by Kendall Shultes, stem cell transplant and cellular therapy clinical pharmacy practitioner, TVHS reported a one-year progression-free survival rate (PFS) of 64.5% and one-year overall survival rate (OS) of 65.5% with patients, which is in comparison to real-world reports.  

PFS refers to the number of people who have been treated for cancer and either have no signs of cancer recurrence or the cancer is stable. OS is a measure of how long a patient can survive. However, it is noted that patients treated for CAR T-cell therapy at TVHS had a higher underrepresented minority population of 27% and patients aged 65 or older at 59%.   

“CAR T-cell therapy is the beginning stages of what we would consider personalized care where it’s not just a broad medication for a broad disease,” said Joel Trushinski, laboratory supervisor for stem cell processing at TVHS. “CAR T-cell therapy advancement shows the time and commitment that not just the VA, but everyone involved has toward our patients.”   

Currently in development, Nashville VA Medical Center will open the only stem cell processing lab in the VA system. With this lab, TVHS will have a functioning stem cell lab program for apheresis, stem cell processing and infusion. The lab will increase the amount of stem cell transplants and different types of biotherapies performed, including CAR T-cell therapy, Trushinski said.  

“[CAR T-cell therapy] is a very, very cool process that is just absolutely exploding all over the scientific market right now,” Trushinski said.   

With TVHS hosting the only center that provides CAR T-cell therapy in the VA system, TVHS receives referrals from “all four corners of the United States,” including California, Alaska and Puerto Rico, Sengsayadeth said.  

TVHS has a quick process for approval since CAR T-cell therapy is an urgent treatment for patients with aggressive lymphomas and leukemias. Once a patient is referred, evaluation is within a few days, and often T-cell collection is within two to three weeks, Sengsayadeth said.   

“I think a lot of people are finding that our center is able to offer it [CAR T-cell therapy] sooner than going into the community because of our expedited process,” Sengsayadeth said.  

With CAR T-cell therapy expanding in the country, TVHS can continue to make advancements in cancer treatment for Veterans. CAR T-cell therapy and the development of the stem cell processing lab allow the health care system to make substantial progress at VA and in the field.   

Bachy E, Le Gouill S, Di Blasi R, et al. Nature Medicine. 2022;28:2145-54.  
Jacobson CA, Locke FL, Ma L, et al. Transplantation and Cellular Therapy. 2022;581.e1-e8.