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Introduction
This information explains what to expect if you have been referred to The Clatterbridge Cancer Centre for chimeric antigen receptor T-cell therapy, usually shortened to CAR-T therapy.
It explains what happens before, during and after your treatment. It also explains the risks and benefits of CAR-T therapy.
You should read this information carefully. Ask your doctor or nurse if there is anything you don’t understand or if you have any questions.
We are here to support you and your family.
Our CAR-T service
The Clatterbridge Cancer Centre provides CAR-T therapy for people in Cheshire and Merseyside and surrounding areas. The service is provided at Clatterbridge Cancer Centre – Liverpool and is accredited by JACIE (Joint Accreditation Committee of the International Society for Cellular Therapy and the European Group for Blood and Marrow Transplantation).
Our CAR-T team includes consultant haemato-oncologists (doctors who specialise in blood cancer) and other doctors, specialist nurses, ward nurses, pharmacists, and a wider care team. We are all here to support you and your family.
If you have any questions or worries at all, please just ask us.
Read more about our CAR-T team.
What is CAR-T therapy?
Chimeric antigen receptor T cell therapy – usually called CAR-T cell therapy or CAR-T – is a very specialist treatment for some types of cancer.
It involves taking T cells from your blood and changing them into a special type of T cell (known as a CAR-T cell) that can recognise and attack cancer cells.
How it works
Watch our video explaining how CAR-T therapy works.
T cells are a type of white blood cell that will destroy anything the body recognises as unhealthy or abnormal – for example, a virus or a cancer cell.
CAR-T therapy involves adapting T cells from the body’s immune system to become CAR-T cells that can recognise and attack cancer cells.
Treatments are specially made for each patient using T cells from their own body.
T cells from the patient’s blood are taken to a special laboratory and converted into CAR-T cells.
CAR-T cells have a special ‘receptor’ that recognises ‘antigens’ – proteins or other molecules associated with the cancer cells.
This means the CAR-T cells can recognise the cancer cells and attach themselves to it. The adapted T cells can then destroy the cancer cells.
There is more information in later sections about what to expect when you come into hospital and what happens after your CAR-T therapy.
Our CAR-T service
The Clatterbridge Cancer Centre provides CAR-T therapy for people in Cheshire and Merseyside and surrounding areas. The service is provided at Clatterbridge Cancer Centre – Liverpool and is accredited by JACIE (Joint Accreditation Committee of the International Society for Cellular Therapy and the European Group for Blood and Marrow Transplantation).
Our CAR-T team includes consultant haemato-oncologists (doctors who specialise in blood cancer) and other doctors, specialist
Is CAR-T therapy right for you?
CAR-T therapy is approved by the NHS for patients with specific types of cancer and who are either unsuitable for other treatments or whose cancer has returned after other treatments.
Sometimes it is also available to patients as part of a clinical trial.
It is an intensive treatment so it can only be given to people whose bodies will be able to cope with it. It is not suitable for anyone who is too frail.
Like any treatment, it has risks and possible side-effects that need to be balanced against the possible benefits.
Your clinical team will discuss this with you. They will be happy to answer any questions you have.
CAR-T therapy is only right for you if:
- Your clinical team decide the benefits outweigh the risks and your body should be able to cope with the treatment, and
- You decide you want CAR-T therapy – your wishes are very important and we will not give you treatment unless you are happy to go ahead with it.
Step 1: Your first appointment
Your first appointment after your referral to our CAR-T therapy team will be in the Outpatients department on Level M1 of Clatterbridge Cancer Centre – Liverpool.
It will usually be with one of the consultant doctors in our CAR-T team. You might also meet other members of the team such as the CAR-T Nurse Coordinator.
Your doctor will explain what CAR-T therapy involves and how it might help treat your cancer. They will also explain the risks and possible side-effects. You can ask them any questions you have.
If you decide you would like CAR-T therapy, we will refer your case to the national CAR-T panel for approval to treat you.
Once approved, we will arrange tests to check you are suitable for CAR-T and that it would be safe for you to have this treatment.
Step 2: Checking you are well enough for CAR-T
When the national CAR-T team approves you for treatment, we will arrange tests to check you are fit enough to have CAR-T therapy.
These tests will include:
- Physical examination, tests and scans to check your pulse, heart rate, breathing and so on.
- Blood tests to check how well your liver and kidneys are working and to check for any signs of infection.
- Blood tests for viruses such as Hepatitis B and C, HIV or syphilis – this is a legal requirement.
You might also need other tests, scans or biopsies so we have up-to-date information about your cancer.
Step 3: Agreeing to have treatment
If you decide you want to go ahead with CAR-T therapy and your tests show you are fit enough for it, we will ask you to sign a consent form confirming you agree to have the treatment.
Before we ask you to sign this form, we will explain the risks and possible side-effects as well as the potential benefits of the treatment.
You can ask any questions you have. It is important you understand what to expect. We will never pressure you to have CAR-T therapy if you do not want it.
Your clinical team will look after you throughout your treatment.
Step 4: Collecting your T cells
The next step is to collect your T cells and prepare your body for CAR-T therapy.
Collecting your T cells is called ‘apheresis’. This will take place in the Therapeutic Apheresis suite on Level 1 of Clatterbridge Cancer Centre – Liverpool. A nurse from NHS Blood and Transplant will put tubes into a vein in each of your arms.
One tube takes blood from your arm to an apheresis machine that separates the blood cells. The machine collects your T cells. The rest of your blood goes back into your other arm through the second tube.
Your T cells go to a special laboratory to be made into CAR-T cells for your treatment. This takes a few weeks.
In the meantime, you might need chemotherapy or radiotherapy to control your cancer and make sure your body is ready for CAR-T therapy. This is known as ‘bridging therapy’.
You will have a PET-CT scan three weeks after bridging therapy to check you are still suitable for CAR-T therapy.
Step 5: Admission to hospital for CAR-T therapy
When your CAR-T cells are ready, you will be admitted to our CAR-T therapy unit on Level 5 of Clatterbridge Cancer Centre – Liverpool.
You will have your own room on Ward 5, which specialises in CAR-T (and other cellular therapies) and stem cell transplants. The ward is specially designed with air filtration to protect people from infection while they recover.
Preparing for treatment
You will have a PICC line (peripherally inserted central catheter) inserted if you don’t already have one – this is a tube that goes into a central vein so we can deliver your treatment through it.
We will give you chemotherapy for 4 to 6 days to prepare your body for CAR-T therapy by reducing the number of white blood cells. This is known as ‘lymphodepletion chemotherapy’. It is given through your PICC line.
Reducing the number of white blood cells in your body before treatment helps the CAR-T therapy to work more effectively.
You will have a 2-day break from treatment before we give you your CAR-T therapy. Giving CAR-T cells or other blood products is known as ‘infusion’.
Your CAR-T infusion
The CAR-T cells arrive frozen so need to thaw before you have them. We will give you medicine – usually paracetamol and antihistamines (anti-allergy) – to help prevent any adverse reaction to the new cells.
The infusion is given through a drip into your arm. This takes about 30 minutes. We will monitor you very carefully in case your body reacts to the treatment.
You will stay in hospital for at least 10 to 28 days afterwards while we check how you are responding to the treatment.
CAR-T is an intensive treatment that can have lots of side-effects so it is important we monitor you closely and keep you in hospital until we know you are well enough to leave.
Please tell us if you feel unwell or have any symptoms after your CAR-T therapy, even if they seem minor.
You can read more about possible risks and side-effects of CAR-T therapy later in the ‘Risks and possible side-effects’ section below Step 6.
Your clinical team will look after you and will help you prepare to leave hospital when you are well enough.
Step 6: Leaving hospital and what to expect afterwards
Your clinical team will talk to you about leaving hospital when you are well enough and they will help you to prepare. They will also explain what happens afterwards, side-effects you might develop and who to contact if you feel unwell after leaving hospital.
We will give you an alert card that explains you have had CAR-T therapy. It includes important contact details if you feel unwell. It also includes important information for other health professionals treating you.
Carry this alert card with you at all times afterwards for the rest of your life – it is important that any health professionals treating you in future know you have had CAR-T therapy.
It is very important to contact your CAR-T nurse or our 24-hour Hotline (0800 169 5555) if you feel unwell or have any of symptoms or side-effects mentioned in this information.
You will need to stay close to Liverpool for at least 28 days from the date you have your CAR-T therapy so you are nearby if you feel unwell. If you live more than an hour away, we will arrange accommodation for you closer to the hospital.
You will also need to have someone with you at all times for at least 28 days from the date you have your CAR-T therapy. This is so they can check how you are, contact us if you become unwell and drive you to Clatterbridge Cancer Centre – Liverpool if you become very unwell and we need to see you.
After this, you will have regular follow-up appointments so we can check how you are responding to the CAR-T therapy.
If you see your GP or another health professional, make sure they know you have had CAR-T therapy at The Clatterbridge Cancer Centre. Show them the alert card we have given you.
Risks and possible side-effects
CAR-T therapy is an intensive treatment with risks that can be very serious or life-threatening. Sometimes the body’s immune system causes side-effects as it responds to the CAR-T therapy.
Your doctor will explain the possible risks and side-effects to you before you agree to have treatment (known as ‘consent’). If you have any questions at all, please just ask them. It is important you understand the possible risks as well as the possible benefits of this treatment.
If you have CAR-T therapy, your clinical team will also explain possible side-effects you might develop when you leave hospital. They will explain what to do and who to contact if you feel unwell or think you might have side-effects.
The most common risks and side-effects are listed below.
Cytokine release syndrome (CRS)
Cytokine release syndrome (CRS) is a common side-effect linked to your immune system. It happens when white blood cells in the immune system get triggered to release substances called cytokines, which trigger more white blood cells and more cytokines.
Cytokines can affect your body in different ways including:
- Fever (high temperature)
- Feeling dizzy or light-headed
- Low blood pressure
- Feeling short of breath
- Racing heart rate
- Chills and shivering
- Muscle weakness or feeling very tired
- Headache
- Bleeding
- Problems with your nervous system such as confusion, loss of coordination or strange sensations
Not everyone gets CRS. If they do, it usually happens in the first couple of days after your CAR-T therapy. Your clinical team can give you medication to help with these side-effects.
Sometimes you might need to be admitted to intensive care until the side-effects ease.
You are unlikely to develop CRS after you leave hospital.
Brain and nervous system (neurological) effects
CAR-T therapy can cause short-term problems with your brain or nervous system. They usually happen around 5 days after your treatment but can also happen in the weeks after you leave hospital. Most people recover completely from them.
We work closely with experts at The Walton Centre, which specialises in the treatment of conditions affecting the brain and nervous system, to make sure you get the best care if you have any side-effects like this.
Sometimes people need to be admitted to intensive care if they become very unwell with these side-effects.
Infections and low blood counts
Your immune system and your blood system both take time to recover and rebuild after CAR-T therapy.
Your blood counts will be lower than normal and you might need transfusions or other treatments in the meantime. Some types of blood cells recover more quickly than others but some can take many months.
Your CAR-T team will explain the signs and symptoms to look out for – especially unusual bleeding or bruising.
You might get infections more easily than normal while your blood cells and immune system rebuild. You might get more unwell with them than usual and you might find it takes you longer to get better afterwards.
It is important to tell your CAR-T team or call our 24-hour Hotline (0800 169 5555) if you have any symptoms such as:
- Temperature above 37.5C or below 36C
- Feeling shivery
- Sweating
- Sore throat
- Diarrhoea
- Difficulty peeing or pain when you pee
- Feeling breathless or coughing
When you leave hospital, we will give you a special card that explains you have had CAR-T therapy and must only be given irradiated blood products (if you need them). Carry this card with you all the time.
Other risks and side-effects
If you feel unwell after your treatment, please tell your CAR-T team or call our 24-hour Hotline (0800 169 5555) for urgent advice. The Hotline is staffed by our specially-trained nurses who can offer advice on any side-effects or complications from cancer treatment.
If they think you need to see a health professional urgently, they will arrange for you to see the right team. This could be at Clatterbridge Cancer Centre – Liverpool, your nearest Emergency Department (A&E) or another suitable healthcare setting.
CAR-T team
Consultant Haemato-Oncologists
Dr Muhammad Saif – Stem Cell Transplant and Cellular Therapy Programme Director
Dr Shahid Iqbal
Dr Yeong Jer Lim
Dr Sajid Pervaiz
Dr Tom Seddon
Dr Gabe Toth
Dr Matt Wells
Senior Registrar
This is a senior doctor who has chosen to become a consultant haematologist and is working towards this.
Clinical Fellow
This is a senior doctor who has chosen to gain more specialised experience within a chosen area of medicine. The role usually involves a supervised clinical workload alongside non-clinical opportunities such as education and research.
Service Lead
Priscilla Hetherington
Advanced Nurse Practitioner
Sally Pickering
CAR-T Nurse Coordinator
Fiona Scanlon
CAR-T Specialist Nurse
Emma Parsons
Stem Cell Transplant Nursing Team
Our CAR-T nurses work closely with the Stem Cell Transplant nursing team, providing collaborative care.
Stem Cell Transplant Nurse Coordinators
Autologous – Clare Hawkins
Allogeneic – Leah Credidio
Stem Cell Transplant Specialist Nurse
Angela Milner
Ward 5 Team
The team is made up of trained nurses, nursing associates, health care support workers, student nurses and a ward clerk. The team is led by Ward Manager Chris Muir. She is supported by a team of senior ward nurses.
Senior Pharmacist
The senior pharmacist ensures that any treatment or chemotherapy you receive is prescribed and administered correctly. She will often review any medications you are already taking to make sure no interactions take place.
Any queries relating to medicines or chemotherapy are dealt with by the pharmacist. The pharmacist might arrange a telephone appointment with you when you are on active treatment. This is to ensure that you are ready for your next treatment dose and are tolerating the treatment well.
Our senior pharmacists are Sophie Hughes and Niamh McLaughlin.
Dietitians
You will receive support from a dietitian to improve your nutrition before CAR-T therapy, during your time in hospital and afterwards. Some people might experience side-effects that affect their eating – the dietitian will advise on ways to help maintain your nutritional intake before, during and after treatment.
Occupational Therapists
The Occupational Therapy team will help you prepare for leaving hospital, including advice, devices or adjustments that might help. They work closely with the Physiotherapy team.
Physiotherapists
The Physiotherapy team will contact you before your treatment, and will continue to review you during your CAR-T therapy and afterwards.
Histopathologists
These are doctors who are experts at identifying cancer cells and carrying out special tests to help our team determine the best treatment option for you.
Radiologists
These are doctors specially trained to carry out diagnostic tests and interpret X-rays and scans, e.g. CT, PET/CT, MRI, and ultrasound.
Clinical Oncologists
These are doctors specially trained in using radiotherapy to treat cancer.
Patient Counsellor
Linda Boyne is the counsellor for patients with blood cancer. She supports patients and their families and works Mondays and Tuesdays. She can meet people face-to-face or speak over the telephone. Linda also runs the patient support group which takes place monthly.
If you feel you’d like to join the group or speak to Linda privately, please ask one of the team.
Clinical Psychologist
Sometimes patients require more advanced psychological support. Often, one of the team will suggest this to you if they feel it is in your best interests. You might then be referred to the psychology specialist team who will see you separately.
Contact details
Our Cancer Information and Support Centres provide information and support for all aspects of living with cancer, including local support groups, practical advice, emotional wellbeing, benefits and finances, Blue Badge enquiries, prescription charge exemptions, wig vouchers, and much more.
They are available from 8:00am to 4:00pm (08:00-16:00), Monday to Friday.
- Visit them in our Clatterbridge Cancer Centres (Aintree, Liverpool and Wirral)
- Call them on 0151 318 8805
- Text them on 07867 537671
- Email our Cancer Information and Support Centre team
The Liverpool Haematology Support Group is a support group established in 2003 to support anyone in the region diagnosed with a form of blood cancer, and their families.
The group meet every month in Liverpool and all are welcome. For more information, email our Haematology Counsellor, who runs the group.
Further information
CAR-T therapy at The Clatterbridge Cancer Centre
Liverpool Haematology Support Group
CAR-T cell therapy (Macmillan Cancer Support)
CAR-T cell therapy (Cancer Research UK)
CAR-T Away from Home Service (Leukaemia Care)
Cost of Living Fund (Leukaemia Care)
This information has been reviewed by Cheshire and Merseyside Cancer Voices to check it is easy to understand. Cheshire and Merseyside Cancer Voices is a panel of cancer patients who volunteer to read NHS information to make sure it makes sense to people. They have been brought together by Cheshire and Merseyside Cancer Alliance.
This information is produced by staff at The Clatterbridge Cancer Centre. It is not sponsored or influenced in any way.
We make every effort to ensure information is accurate and complete - we hope that it will add to any professional advice you have had. Information is based on evidence and accepted guidelines (where appropriate). We review and update it regularly. If you are worried about your health, please tell your clinical team.
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Issue date: August 2025
Issue number: 1.0
Reference: LNUCART
Review date: August 2028