What is the lymphodepleting chemotherapy you receive before CAR T-cell therapy?

00:00:06:11 - 00:00:27:11 Libby Ai Before your car. T cells can be infused. Your body needs to be prepared to welcome them. That's where lymphoid depleting chemotherapy comes in. Think of it as clearing space so your new car T cells can thrive. In this lesson we'll explain what lymphoid depleting chemotherapy does, why it's needed before Car-T therapy, and how it compares to the chemotherapy given before transplant. 00:00:27:14 - 00:00:49:21 Libby Ai By the end of this video, you'll have a clear understanding of this key part of your treatment journey and what to expect along the way. What does lymphoid depletion mean? So we all have immune cells, T cells, NK cells, all these things in our body that if even though the T is from your own T cells, that molecule, that genetic modification that we do is not from your body. 00:00:50:01 - 00:01:07:17 Krina Patel And your own T cells are smart enough to find it, just like they find viruses and other infections when we give you those. If we didn't do depletion chemo, what would happen is we give those cells your immune system, kills them off so they don't even get a chance to find the myeloma because your your immune system is going to say, this isn't supposed to be here. 00:01:07:20 - 00:01:28:04 Krina Patel So lymphoid actually knocks down those lymphocytes. So you're like I said your T cells and K cells B cells so that your immune system is lower. And then when we give the T cells they can actually make it to the myeloma do what they need to do. They start growing. And then in a week or so that lymph depletion chemo stops working, your immune system comes back. 00:01:28:05 - 00:01:44:05 Krina Patel And then it does start taking out some of those T cells, which is what we want. We don't want those T cells at the highest level being there all the time. After they've done what they've done, we'd like for most of them to go away. What drugs are used for lymphoid depleting chemotherapy? Are patients hospitalized while receiving it? 00:01:44:06 - 00:02:02:00 Krina Patel So lymphoid chemo for the most part is two drugs right now cyclophosphamide and flu. Darebin. And those are the ones that really we know. Knock down your T cells well enough and long enough. And that's why I said we don't like to use site toxin or been to Mustang prior to aphorisms because we know it kills your T cells. 00:02:02:01 - 00:02:21:17 Krina Patel Right. So that's the main reason. So now we do want to kill them. We want them to be knocked down. So we use cytokine and usually for three days. And most patients will get it outpatient because this is just chemo. But it's every day for three days. And if my patients are really sick or they might have some kidney issues, then maybe we do it inpatient. 00:02:21:17 - 00:02:43:18 Libby Ai But for most it's outpatient and then you get two days of rest. For the most part, although most FDA approved car T therapies use flutter, a bean and cyclophosphamide, usually given for three days, the exact dose and schedule depend on car T product, and alternative regimes may sometimes be used. Talk to your doctor about the lymphoid depleting chemotherapy you will receive and what to expect. 00:02:43:20 - 00:03:07:11 Krina Patel How long are the lymphoid depleting chemotherapy infusions? Depletion. Chemo usually is a few hours long. The the main part is they tech your blood counts. Make sure you're okay. It depends on the institutions. We tend to give fluids before and possibly even after, just to make sure patients, kidneys and everything else gets flushed out. Very few patients will get something called Messina. 00:03:07:12 - 00:03:23:20 Krina Patel It. Most patients don't. But if you've had a lot of site toxin, it can cause bladder irritation. So if someone's on on Messina then it's a 24 hour pump that we do. But again most patients don't need that. It's just a couple of my patients were surprised that they needed that. So I like to make sure everyone knows everything. 00:03:23:21 - 00:03:43:14 Krina Patel But again, it's usually just a few hours and then you're done. And then you come back the next day. And it should be the same for all three days. And the main part is the if we're giving pre and posts, normal saline or if someone's kidneys are a little bit, you know, on the borderline or if I'm not giving any fluids, then it turns it into just a couple of hours. 00:03:43:18 - 00:04:10:20 Amy Rockas What is the difference between the chemotherapy that is given for a stem cell transplant and the lymphoid depleting chemotherapy before car team? What I like to tell my patients about lymphoid depleting chemo is it's a kinder, gentler chemotherapy. The goal is not to wipe anything out. The goal is to just suppress the level of T cells in your body, so that when we give you your car cells back, your body doesn't overreact and doesn't reject them. 00:04:10:21 - 00:04:28:17 Cindy Varga & Amy Rockas Right. And it kind of sets up the tone, the mood. Right. Get to get those T cells in. Yeah. And it's pretty mild. And they usually get it over three days right. Yes. It's three days. Each appointment is probably going to be about four ish hours. You may have some nausea which we can manage with medication. Right. 00:04:28:18 - 00:04:52:18 Cindy Varga & Amy Rockas You may have some fatigue. Your hair will not fall out, although it may thin, but it's not going to be hugely noticeable at all. Right. And I think some patients, you know, will mention that they're having some mild residual nausea afterwards, which is normal. And we have medications to counteract that. But usually it's pretty mild. And I think most patients tolerate it well. 00:04:52:18 - 00:05:11:22 Cindy Varga & Amy Rockas But by the time they get their car t infusion they're feeling quite well. Exactly. There can be some blood counts that come down for a transient amount of time, but they do recover. And if we have to, we can always support blood counts, you know, if we need to. But, you know, it's that white blood cell count that will come down and then come back up. 00:05:12:04 - 00:05:42:01 Cindy Varga & Amy Rockas Yes, absolutely. However, for, you know, philanthropy or beam therapy, which we give for our lymphoma patients and we give for our myeloma patients who are getting stem cell transplant, that's a whole different cup of tea. It is. Yeah, it is. And that's actually my least favorite part of the job is to tell people that the whole goal of the Flynn or the beam therapy is to completely wipe out the bone marrow, because when we infuse those stem cells, we want them to proliferate in a clean environment. 00:05:42:06 - 00:06:02:00 Cindy Varga & Amy Rockas And we can't do that unless we wipe out all the bad stuff in the marrow beforehand. Right? So if we're, you know, with that therapy, just as you mentioned, we're kind of wiping out the whole bone marrow, the good cells, the bad cells, everything. That bone marrow will not recover without stem cells. And so we know that it's a really big dose of chemotherapy that we're giving if it does that. 00:06:02:02 - 00:06:21:07 Cindy Varga & Amy Rockas And so it can affect, you know, our mucosa it causes inflammation in the mouth down. You know we have mucus in our mouth and our esophagus and our GI tract. And so many patients have GI problems. Right GI symptoms. Yes. And when we're giving them an infusion we'll ask you to keep your mouth cold. We'll ask you to crunch ice. 00:06:21:07 - 00:06:37:02 Cindy Varga & Amy Rockas We'll ask you to drink cold drinks, to try to close off the blood vessels in the mouth, so that the mouth blend can have a minimal impact in your mouth. Yeah. And the goal is to prevent those ulcers that we don't like, right. Because we want patients to be able to eat as much as they can during the transplant. 00:06:37:05 - 00:07:02:14 Cindy Varga & Amy Rockas And so patients can have no issues with swallowing. Not everybody, but some some patients can have diarrhea. Some patients have nausea. And again vomiting which we can always intervene on and type trait medications to prevent. But yes, unfortunately with the fallen and the beam we do have the hair loss which does grow back. But it's definitely not on the same level as the lymphoid depletion chemo that we mentioned where we don't have those side effects. 00:07:02:16 - 00:07:23:20 Cindy Varga & Amy Rockas Exactly. And I hope this helps kind of differentiate between the two. Chemo even though, you know, both are considered cellular therapy. You know the mechanism of action is completely different. The chemotherapy that we use is completely different. And so I hope this clarifies this for for some folks. Now you know how lymphoma depleting chemo prepares your body for car t therapy. 00:07:23:22 - 00:07:29:23 Libby Ai Watch the other videos in this Health Tree University course to learn more about side effects, infusion and follow up care.