The first foreign patient to receive cancer treatment using the newly approved chimeric antigen receptor T-cell therapy (CAR-T) at Shanghai Jiahui International Hospital has successfully completed her treatment and been discharged.
On the 13th of September 2023, the patient was successfully discharged from the hospital three weeks after receiving CAR-T cell infusion.
Since the approval and launch of CAR-T therapy in China, Shanghai Jiahui International Cancer Center (JICC) has collaborated with both domestic and international partners to actively establish an international-standard CAR-T treatment protocol, share clinical experience, exchange academic progress, and provide blood cancer education to their doctors and nurses.
The CAR-T multidisciplinary treatment team, led by Dr. Vicky LEE, Director of the Jiahui International Cancer Center and Chief of Medical Oncology at JICC, has been doing a series of explorations in the clinical practice of novel concepts and technologies, aiming to bring hope and new treatments to more patients with blood cancers.
The first foreign patient in China who received CAR-T treatment with Axicabtagene Ciloleucel injection has successfully completed treatment after three weeks of CAR-T cell infusion. On the day of discharge, Jiahui’s medical teams who supported the patient throughout her treatment journey gathered with the patient, her family, and friends to congratulate her on the success of her CAR-T treatment.
The patient, a mother of three from Singapore, was diagnosed with primary mediastinal large B-cell lymphoma in 2022. This subtype of lymphoma is considered relatively rare and prognosis is poor, occurring predominantly in younger individuals, particularly in women.
Following the diagnosis, the JICC team immediately established a multidisciplinary team discussion (MDT) and made a comprehensive treatment plan for the patient. After the patient underwent a range of comprehensive treatments, including combined target therapy and chemotherapy as well as radiation therapy, she did not achieve complete remission. The size of the lymphoma reduced to half of its original size but began to grow again shortly after the comprehensive treatment. Due to rapid cancer progression, the patient needed urgent treatment.
On 26 June 2023, CAR-T immunotherapy was officially approved in China for the second-line treatment of adult large B-cell lymphoma.
CAR-T therapy, or chimeric antigen receptor T-cell therapy, is a major breakthrough in personalized cellular immunotherapy for cancer. The process involves the collection of the patient's T-cells, after which in vitro genetic engineering modifications of T-cells are made to enhance the T-cells' ability to specifically recognize cancers. These modified T-cells (i.e., CAR-T cells) are then infused back to the patient. The treatment enables the accurate killing of cancer cells and the formation of memory T-cells that fight the cancer in the long term and ensure a more sustainable remission.
Currently, CAR-T therapy has been approved in China for the treatment of lymphoma and multiple myeloma. CAR-T therapy is individualized in nature and involves many key aspects such as patient screening, bridging therapy, adverse reaction management, and long-term follow-ups. This requires a highly specialized, experienced, and responsible hematology team as well as a comprehensive multispecialty team. It requires strong collaboration among multispecialty groups including hematology, cardiology, pulmonology, neurology, ICU, experienced nursing teams, etc.
It was determined by the multidisciplinary team (MDT) that the advanced CAR-T treatment was suitable for this specific case.
The patient selected Jiahui Health for her CAR-T treatment on the basis of the international standard hematology team led by Dr. Vicky Lee, who was trained in the US and has worked as a hematologist and oncologist in the US for decades and has rich CAR-T therapy experience, as well as the available comprehensive multiple specialty teams at Shanghai Jiahui International Hospital. Additional advantages of CAR-T therapy at Jiahui include no waiting time and lower costs in comparison to other countries. Over and above this, it also meant that the patient could stay in Shanghai with her family during her treatment – it is where she and her family have been living for a long time.
Jiahui is the first international hospital in Shanghai that is able to perform CAR-T treatment, with Dr. Vicky Lee providing her in-depth CAR-T clinical experience and knowledge.
The CAR-T treatment, led by Dr. Vicky Lee and Dr. Lily Zhou, from the Department of Hematology, required strong collaborations with multiple specialties and departments across Jiahui, including Cardiology, Neurology, ICU, Pulmonology, Gastroenterology, Nephrology, Medical Imaging, Laboratory, Pharmacy, and various other departments. The nursing team from Jiahui International Cancer Center collaborated to conduct multiple training sessions and scenario simulations in the CAR-T treatment reparation, with the aim of staying up-to-date with the patient's evolving condition in a timely manner.
After pre-collection evaluation and infection assessments, Jiahui’s hematology team collected cells from the patient on 19 July 2023, gave the patient bridging therapy, and then successfully completed CAR-T cell infusion on 21 August 2023.
“In the whole CAR-T treatment process, there are several courses that are crucial. One is the T-cell collection stage, which requires a professional medical team, with the help of sophisticated equipment, to collect enough T-cells in a relatively short period of time.
The second is the time from completing the collection to the transfusion of CAR-T calls back into the patient. The aim during this stage is to avoid further progression of the disease, so that the patient has a smooth transition to the day of the CAR-T infusion. Therefore, Jiahui’s Hematology team made a comprehensive treatment plan to control the cancer to an optimal condition before CAR-T infusion.
Third, after CAR-T cell infusion, there are several serious complications that may occur, including but not limited to cytokine release syndrome (CRS, also known as cytokine storm) and immune effectors cell-associated neurotoxicity syndrome (ICANS). These complications require expertise and extensive professional care from multiple specialty teams, and need to be monitored closely by the clinical team."
- Dr. Vicky Lee
After CAR-T cell infusion was completed, Jiahui’s multidisciplinary team closely monitored the patient’s physical conditions, symptoms, signs of infection, and lab tests.
Seven days after infusion, the patient developed cytokine release syndrome symptoms, including fever, chills, hypotension, tachycardia, and vomiting. Jiahui's medical team responded rapidly to manage the patient’s condition based on the previously established emergency plan, and the patient’s critical condition was controlled quickly.
Several weeks after the CAR-T cell infusion, the patient's pain associated with her cancer was reduced. After clinical evaluation in early September, the patient’s condition was stable, and she moved from the dedicated CAR-T isolation room to a regular room.
On 13 September, the patient was successfully discharged from the hospital and could go home. She still requires long-term monitoring and follow-up, but the most difficult step is now over.
The Jiahui International Cancer Center at Shanghai Jiahui International Hospital has completed multiple CAR-T training certifications and has been authorized to perform CAR-T cell therapy. Shanghai Jiahui International Hospital has a highly experienced and responsible CAR-T treatment team, an advanced T-cell harvesting machine, and a dedicated CAR-T ward, to ensure patients’ safety and ensure patients receive cutting-edge treatment. Jiahui also provides strong psychological and emotional support during the cancer journey to ensure patients are safe and comfortable at all times.
Because of its individualized and customized nature, the total cost of CAR-T treatment is high. However, the cost of CAR-T therapy in other countries is approximately 3 to 5 times higher than in China*.
The CAR-T therapy costs mainly consist of two parts, namely drug costs and non-drug costs. Various payment methods, including commercial insurance, have been made available at Jiahui.
*The total cost of CAR-T therapy in China varies depending on the patient’s condition, management of adverse reactions, emergency services, etc. Please note that this data is for reference only. Please contact JICC for further information.