Whether you or someone you know/love is a patient who is having CAR-T and receiving Carvykti, here is a rundown of the flow that I will be going through over the next roughly two months. These steps are built around my specific treatment needs, representing the latest scientific and medical knowledge in support of the: preventive preparation, administration (infusion), and critical follow-up monitoring associated with the process.
- My T-cells have been harvested, sent to the lab for re-engineering, successfully completed, and are now ready to be infused back into my body
- Receive PICC line (Peripherally Inserted Central Catheter) to facilitate: the series of incoming IV therapies, post-procedure blood draws for critically important evaluative lab work, and possible adverse effects treatments/meds
- Three successive days of 3-4 hour lymphodepleting chemotherapy sessions to reduce the number of existing T-cells in my body, creating space and a more favorable environment for the coming CAR T-cells to engraft, expand, and exert their therapeutic effect
- Two-day break to allow my body to rest and prepare for the Carvykti CAR-T procedure
- Day 0: Infusion of my T-cells which have been genetically modified to recognize and attack my cancer cells - about a 3-4 hour process in the clinic
- This is also the beginning countdown of an 8-week period when I am not allowed to "operate heavy machinery" (ie: drive a car by myself)
- Three successive days of brief visits for lab work and neurological testing - looking for adverse effects such as cognitive impairment, which may manifest as confusion, difficulty concentrating, and language or memory problems. While generally reversible, these neurological complications can be serious and require prompt management
- Day 4: Proactively check into the hospital for further monitoring of the aforementioned known short-term side effects; as well as Cytokine Release Syndrome (CRS) - ie: fever, headache, rapid heartbeat, nausea, etc. This can happen when your immune system responds to immunotherapy drugs (ie: CAR-T process) more aggressively than it should. Early recognition and prompt treatment are crucial for a positive outcome
- About 6-10 days in the hospital (though not in isolation, like when I had the Stem Cell Transplant), to continue monitoring for CRS or neurological issues - so that they can be recognized and treated as quickly as possible
- Roughly Day 15: Released from the hospital and then approximately 14 more days of potentially thrice-weekly brief visits to get lab work for ongoing observation of waning CRS or other tangential concerns
- Day 30: That all will take about a month, which leaves one more month of "no driving" - otherwise fully functional; just can't drive myself
I refer to this flow as a progression because this is hopefully going to help progress the management of my Multiple Myeloma to the point where I will no longer need: chemo of any kind (current regimen of daily small-dose pills; 21 days on / 7 days off), or monoclonal antibody boosters (existing routine of once-a-month subcutaneous Darzalex Faspro). Stay tuned.
