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RGCIRC, Niti Bagh
CAR-T Cell Therapy in Delhi
Overview
For patients with blood cancers not responding to chemotherapy, targeted therapy, or even bone marrow transplantation, treatment choices can become limited. CAR-T cell therapy has emerged as an advanced treatment option for selected patients in this situation, offering the possibility of durable remission when previous lines of treatment have not been effective.
Unlike conventional treatments that are given over repeated cycles, CAR-T cell therapy is a personalized cellular immunotherapy delivered through a highly specialised process. For some eligible patients with relapsed or refractory blood cancers, it may support long-term, treatment-free remission under expert monitoring and follow-up.
At RGCIRC, Rajiv Gandhi Cancer Institute and Research Centre, CAR-T cell therapy is delivered through a specialised programme led by Dr Dinesh Bhurani , who has conducted the highest number of CAR-T procedures in Northern India. The programme is supported by a dedicated 22-bedded HEPA-filtered Bone Marrow Transplant Unit, a round-the-clock blood bank, and the multidisciplinary expertise of one of India’s most established oncology institutions.
What is CAR-T Cell Therapy?
CAR-T cell therapy is a personalized, one-time cellular treatment that uses a patient’s own immune cells to fight cancer. In this treatment, T-cells, which are the immune system’s natural cancer-fighting cells, are collected from the patient’s blood and genetically modified in a laboratory to recognise a specific protein present on cancer cells. These modified cells are then multiplied into hundreds of millions of copies and infused back into the patient’s bloodstream.
Once inside the body, the engineered T-cells identify cancer cells carrying the target protein, attach to them, and destroy them. These cells can also multiply further inside the body, allowing them to continue attacking cancer cells after the infusion.
The “CAR” in CAR-T stands for Chimeric Antigen Receptor. It is an artificial receptor added to the surface of the T-cell through genetic engineering. This receptor is designed to recognise a specific antigen that is present on cancer cells and absent or rarely found on healthy cells. When the CAR receptor detects this antigen, it activates the T-cell to attack the cancer cell and create more CAR-T cells to continue the immune response.
How CAR-T Differs from Other Cancer Treatments
CAR-T cell therapy is different from conventional cancer treatments in the way it is designed, delivered, and sustained in the body. While treatments such as chemotherapy, radiation therapy, and stem cell transplantation remain important in cancer care, CAR-T works by using modified immune cells to identify and attack cancer cells in selected patients.
CAR-T vs Chemotherapy
Chemotherapy acts on rapidly dividing cells throughout the body, which means it can affect both cancer cells and healthy cells. This is why chemotherapy may cause side effects such as hair loss, nausea, and bone marrow suppression. CAR-T therapy is more targeted, as the engineered T-cells are designed to recognise cells displaying a specific cancer-associated antigen, helping reduce damage to most healthy tissues.
CAR-T vs Radiation Therapy
Radiation therapy is a local treatment that works only in the area where it is directed. CAR-T cell therapy, on the other hand, is systemic. Once infused into the bloodstream, the engineered T-cells can circulate throughout the body and target cancer cells wherever they are present.
CAR-T vs Stem Cell Transplantation
Stem cell transplantation replaces the patient’s diseased blood cell production with healthy donor cells and uses the donor immune system to help fight residual cancer through the graft-versus-leukaemia effect. CAR-T cell therapy does not require a donor. It uses the patient’s own T-cells, which are modified to recognise and attack cancer cells. CAR-T may be considered for patients whose disease has not responded to stem cell transplantation, and in some indications, it may also be used as an alternative to transplantation.
CAR-T vs Conventional Drug-Based Treatment
Unlike chemotherapy drugs, CAR-T cells are living immune cells. After infusion, they may multiply, remain active in the body, and continue immune surveillance for months or even years in some patients.
How Does CAR-T Cell Therapy Work?
CAR-T cell therapy is a multi-step treatment process that takes several weeks, from collecting the patient’s T-cells to modifying them in a laboratory and infusing them back into the body. Understanding each step can help patients and families know what to expect before, during, and after treatment.
Step 1: Collection of T-Cells Through Leukapheresis
The process begins with leukapheresis, a procedure in which the patient’s blood is passed through an apheresis machine. The machine separates T-cells from the other blood components and returns the remaining blood to the patient.
The collected T-cells are then sent to a specialised manufacturing facility for further processing. Leukapheresis usually takes three to five hours, is performed on an outpatient basis, and is generally well tolerated. At RGCIRC, leukapheresis is performed in the dedicated haemato-oncology unit by an experienced team.
Step 2: Genetic Engineering of T-Cells
In the laboratory, a viral vector, most commonly a lentivirus, is used to introduce a new gene into the collected T-cells. This gene helps the T-cells produce the chimeric antigen receptor, or CAR, an artificial surface protein that enables the modified T-cells to recognise a specific cancer cell target.
For most B-cell malignancies treated with CAR-T cell therapy, the target antigen is CD19, a protein found on the surface of B-cells, including leukaemia and lymphoma cells. In multiple myeloma, the target is BCMA, or B-cell maturation antigen. This engineering process takes several days in the manufacturing facility.
Step 3: CAR-T Cell Manufacturing and Expansion
After genetic modification, the T-cells are cultured and multiplied in the laboratory. This process, known as expansion, continues until hundreds of millions of CAR-T cells have been produced.
Before being released for clinical use, the cells are quality-tested for potency, purity, identity, and safety. The manufacturing period typically takes two to four weeks, depending on the specific CAR-T product. During this waiting period, some patients may receive bridging therapy, which is a short course of treatment used to control the cancer while the CAR-T cells are being manufactured.
Step 4: Conditioning Chemotherapy
Before CAR-T cell infusion, the patient receives a short course of lymphodepleting chemotherapy, most commonly fludarabine and cyclophosphamide given over three days. This treatment reduces the number of existing immune cells in the body.
Although it may seem counterintuitive to give chemotherapy before an immune-based treatment, this step is important. By creating space for the incoming CAR-T cells, conditioning chemotherapy helps establish a more favourable environment for the engineered cells to expand and work effectively after infusion.
Step 5: CAR-T Cell Infusion
The prepared CAR-T cells are infused back into the patient’s bloodstream through an intravenous infusion. The process is similar to a blood transfusion and typically takes 30 to 60 minutes.
Patients are admitted to the hospital for close monitoring immediately after the infusion. At RGCIRC, CAR-T cell infusion takes place in the 22-bedded HEPA-filtered Bone Marrow Transplant Unit, where the clinical team closely monitors patients for early signs of cytokine release syndrome and neurological toxicity in the hours and days that follow.
Step 6: How CAR-T Cells Attack Cancer Cells
Once infused, CAR-T cells circulate through the bloodstream and lymphatic system, scanning for cells that display the target antigen. When a CAR-T cell identifies a cancer cell carrying that antigen, the CAR receptor binds to it and activates the T-cell.
The activated T-cell then releases cytotoxic molecules, including perfin and granzymes, which help destroy the cancer cell. At the same time, activation triggers the CAR-T cell to multiply, producing more CAR-T cells that continue the attack.
This ability to expand in response to cancer cells is what makes CAR-T therapy different from conventional drug-based treatments. The treatment can amplify itself at the disease site, and in some patients, the expanded CAR-T cells may persist in the body for months to years, helping provide ongoing protection against disease recurrence.
Which Blood Cancers are Treated with CAR-T Cell Therapy?
CAR-T cell therapy is used for a defined group of blood cancers, particularly relapsed or refractory B-cell malignancies and multiple myeloma in selected patients. The exact eligibility depends on several factors, including the type of cancer, previous treatments received, disease status, age, overall health, regulatory approval, and availability of the appropriate CAR-T product.
At RGCIRC, CAR-T cell therapy is offered only after detailed clinical evaluation and review by the Multidisciplinary Tumour Board to determine whether the treatment is suitable for the individual patient.
Acute Lymphoblastic Leukaemia (ALL)
CD19-targeted CAR-T therapy was first approved for B-cell acute lymphoblastic leukaemia and remains one of the strongest indications for this treatment. It may be considered for relapsed or refractory B-cell ALL, including in children and young adults up to 25 years of age, as well as selected adult patients depending on the approved CAR-T product and clinical eligibility.
In pivotal clinical trials, complete remission rates of around 70 to 90% have been reported in patients who had already received multiple prior lines of treatment, including bone marrow transplantation. At RGCIRC, both adult and paediatric ALL patients are evaluated for CAR-T eligibility, with the Paediatric Haematology and Oncology service working closely with the Bone Marrow Transplant Unit for paediatric cases.
Diffuse Large B-Cell Lymphoma (DLBCL)
Diffuse large B-cell lymphoma, or DLBCL, is the most common aggressive non-Hodgkin lymphoma and is one of the most established CAR-T indications globally. CD19-targeted CAR-T therapy may be considered for patients with relapsed or refractory DLBCL after two or more prior lines of systemic therapy.
Across pivotal trials, overall response rates of around 50 to 65% and complete response rates of around 30 to 40% have been reported. Some patients who achieve complete response may experience durable remission, making CAR-T an important treatment option when standard therapies have not been effective.
Multiple Myeloma
For relapsed or refractory multiple myeloma, CAR-T therapy targets BCMA, or B-cell maturation antigen, a protein commonly found on myeloma cells. BCMA-targeted CAR-T therapy may be considered for eligible patients who have received multiple prior lines of treatment, including an immunomodulatory agent, a proteasome inhibitor, and an anti-CD38 antibody.
In heavily pre-treated patients, overall response rates above 70% have been reported across approved CAR-T products. This is significant because these patients have usually already exhausted several standard treatment options.
Mantle Cell Lymphoma
CD19-targeted CAR-T therapy has shown significant clinical activity in relapsed or refractory mantle cell lymphoma. In pivotal trials, overall response rates above 80% have been reported in selected patients.
CAR-T may be especially relevant for patients whose disease has progressed on or after BTK inhibitor therapy, where treatment options have historically been limited.
Follicular Lymphoma and Other B-Cell Malignancies
CD19-targeted CAR-T therapy has also expanded to follicular lymphoma as an approved indication in some settings. It may be considered for selected patients with relapsed or refractory disease after prior lines of therapy, depending on the approved product and clinical suitability.
Research is also ongoing for other haematological malignancies, including chronic lymphocytic leukaemia, T-cell lymphomas, acute myeloid leukaemia, and other blood cancers. At RGCIRC, every case is reviewed by the Multidisciplinary Tumour Board using the latest evidence-based guidelines to assess whether CAR-T cell therapy is appropriate.
Who is Eligible for CAR-T Cell Therapy?
CAR-T cell therapy is not suitable for every patient with blood cancer. It is a complex and highly specialised treatment recommended only in specific clinical situations. At RGCIRC, eligibility is determined through a structured evaluation by the Haemato-Oncology team.
Eligibility Criteria
A patient may be considered for CAR-T cell therapy if they have a confirmed diagnosis of a blood cancer for which CAR-T is approved, and if the disease has relapsed or become refractory after the required number of prior treatment lines for that indication.
Other important eligibility factors include adequate heart, lung, liver, and kidney function to tolerate conditioning chemotherapy, a performance status that allows the patient to manage treatment and recovery, and no active uncontrolled infection at the time of treatment. Patients should also not have active autoimmune disease requiring systemic immunosuppression. In most cases, patients who have already received CAR-T therapy targeting the same antigen may not be eligible for the same approach again.
When Doctors Recommend CAR-T Cell Therapy
CAR-T cell therapy is usually recommended when the cancer has relapsed after stem cell transplantation, or when it remains refractory after two or more lines of standard systemic treatment and continues to progress. It may also be considered when a patient is not suitable for allogeneic stem cell transplantation due to age, organ function, or the absence of a suitable donor.
In some cases, the molecular characteristics of the disease and the patient’s previous treatment history may make CAR-T the option most likely to achieve durable remission. At RGCIRC, this decision is made through the Haemato-Oncology Multidisciplinary Tumour Board, which reviews clinical, pathological, and patient-specific factors before recommending treatment.
Adult and Paediatric Eligibility
CAR-T cell therapy may be used in both adult and paediatric patients, depending on the specific CAR-T product, cancer type, and treatment indication. For paediatric B-cell acute lymphoblastic leukaemia, many approved products include patients up to 25 years of age.
At RGCIRC, the Paediatric Haematology and Oncology service works closely with the Bone Marrow Transplant Unit to evaluate and manage paediatric CAR-T candidates. This ensures that treatment planning, supportive care, and family support are tailored to the needs of younger patients.
Medical Evaluation Before Treatment
Before CAR-T eligibility is confirmed, patients undergo a comprehensive pre-treatment evaluation. This includes a full staging workup and response assessment imaging to understand the current disease status, along with a bone marrow biopsy to confirm the extent of marrow involvement.
The evaluation also includes cardiac assessment, such as an echocardiogram, to check baseline heart function before conditioning chemotherapy, along with pulmonary function tests to assess lung function. A comprehensive blood panel is performed to review complete blood count, organ function, coagulation profile, and markers of inflammation.
Infectious disease screening is also done for hepatitis B, hepatitis C, HIV, CMV, and EBV. A baseline neurological assessment is performed so that any neurological symptoms, including ICANS-related changes after infusion, can be compared with the patient’s pre-treatment status.
The results of this evaluation help determine whether the patient is eligible for CAR-T cell therapy and what safety precautions may be required during treatment.
CAR-T Cell Therapy Success Rates
Success rates with CAR-T cell therapy vary depending on the type of blood cancer, disease burden at the time of infusion, previous treatments, patient fitness, and the specific CAR-T product used. Published clinical trial data provides useful guidance, but individual outcomes can differ from patient to patient.
At RGCIRC, expected outcomes are discussed individually during the treatment planning consultation. Population-level statistics help provide context, but they do not predict the result for a specific patient.
Expected Response Rates by Indication
In paediatric and young adult B-cell acute lymphoblastic leukaemia, complete remission rates of around 70 to 90% have been reported in pivotal clinical trials involving patients who had already received multiple prior treatments.
In diffuse large B-cell lymphoma, overall response rates of around 50 to 65% and complete response rates of around 30 to 40% have been reported. Some patients who achieve a complete response may experience durable long-term remission.
In multiple myeloma, overall response rates above 70% have been reported with approved BCMA-targeted CAR-T products in heavily pre-treated patients. In mantle cell lymphoma, overall response rates above 80% have been reported in pivotal trials.
These figures are based on clinical trial populations that met strict eligibility criteria. Individual outcomes depend on disease biology, tumour burden, molecular features, previous treatments, and the patient’s ability to support CAR-T cell expansion.
Factors Associated with Better Outcomes
Several factors have been linked with better CAR-T outcomes in published clinical literature. One of the most important is lower disease burden at the time of infusion, meaning there is less cancer for the CAR-T cells to overcome.
Good performance status, adequate organ function, and the ability to tolerate conditioning chemotherapy may also support better treatment response. Other favourable factors can include the absence of extensive extramedullary disease, suitable tumour biology, and continued expression of the target antigen, such as CD19 or BCMA, on cancer cells.
This is why bridging therapy may be used in selected patients before CAR-T infusion. It can help control the disease while the CAR-T cells are being manufactured and may improve the patient’s condition before treatment.
Factors That May Reduce Treatment Response
Some factors may reduce the likelihood of a strong or durable response. These include high tumour burden at the time of infusion, poor performance status, severe organ dysfunction, uncontrolled infection, or disease that has already lost expression of the target antigen.
Prior treatment with a therapy targeting the same antigen may also affect response in some patients, especially if cancer cells have changed in a way that makes them harder for CAR-T cells to recognise.
Because these factors vary from person to person, CAR-T cell therapy decisions at RGCIRC are made after detailed clinical evaluation and Multidisciplinary Tumour Board review.
What to Expect: Before, During, and After CAR-T Cell Therapy
CAR-T cell therapy takes place over several weeks, from the first assessment to the completion of early post-infusion monitoring. Knowing the full timeline can help patients and families prepare practically, medically, and emotionally for each stage of treatment.
Before Treatment: Assessment, Bridging Therapy, and Leukapheresis
The process begins with a comprehensive eligibility assessment at RGCIRC’s Haemato-Oncology unit, including the full pre-treatment medical evaluation described above. If the patient is confirmed as eligible, leukapheresis is scheduled to collect T-cells. This is usually a three to five-hour outpatient procedure.
After collection, the T-cells are sent to a manufacturing facility, where CAR-T cell production typically takes two to four weeks. If the disease is progressing during this period, bridging therapy may be given to help control the cancer while the cells are being prepared. This may include a short course of chemotherapy, targeted treatment, or radiation to selected sites.
Bridging therapy is not intended to achieve deep remission. Its goal is to stabilise the disease until the CAR-T cells are ready. Once manufacturing is complete, the patient is admitted to the hospital for conditioning chemotherapy.
During Treatment: Conditioning, Infusion, and Hospitalisation
Around two to seven days before the CAR-T infusion, the patient is admitted and begins conditioning chemotherapy, usually with fludarabine and cyclophosphamide given over three days. This prepares the body for the CAR-T cells by creating a more favourable environment for them to expand after infusion.
After conditioning is complete, the CAR-T cells are thawed and infused into the bloodstream through an intravenous line. The infusion itself is similar to a blood transfusion and usually takes 30 to 60 minutes. It is generally well tolerated, but the most important clinical changes often begin in the hours and days after infusion.
Patients are monitored in the hospital for a minimum of seven to fourteen days after infusion. At RGCIRC, this monitoring takes place in the 22-bedded HEPA-filtered Bone Marrow Transplant Unit. The clinical team, including haematologists, BMT nurses, intensivists, and infection control specialists, closely monitors patients for cytokine release syndrome and immune effector cell-associated neurotoxicity syndrome, also known as ICANS.
This close monitoring period is the most clinically intensive phase of CAR-T cell therapy.
After Treatment: Early Recovery and Follow-Up
After discharge, patients are advised to remain within 30 to 60 minutes of RGCIRC for at least four weeks because delayed cytokine release syndrome or neurological toxicity may still occur during the early post-infusion period. Weekly outpatient clinic visits and blood tests are usually scheduled during this time.
Patients are also advised to avoid driving, crowded public spaces, and any situation where emergency medical care may not be quickly accessible during the first four weeks after infusion.
The first formal response assessment is usually performed around day 30 and day 90 after infusion. This may include CT imaging and bone marrow biopsy, where indicated. These assessments help determine whether the cancer has responded, confirm the depth of remission, and guide further monitoring or treatment decisions.
Risks and Side Effects of CAR-T Cell Therapy
CAR-T cell therapy is a complex and powerful treatment. The immune activation that helps CAR-T cells attack cancer can also cause significant side effects, some of which may be serious and require specialist management. Understanding these risks before treatment helps patients and caregivers recognise early warning signs and seek medical help promptly.
Cytokine Release Syndrome
Cytokine release syndrome, or CRS, is one of the most common serious side effects of CAR-T cell therapy. It may occur in 50 to 90% of patients, with severity varying from mild to severe.
CRS happens when CAR-T cells become highly active after recognising cancer cells, leading to the release of large amounts of inflammatory signalling proteins called cytokines into the bloodstream. Mild CRS, usually Grade 1 to 2, may cause fever, fatigue, headache, and muscle aches, and is often managed with supportive care and fever-reducing medicines.
Severe CRS, usually Grade 3 to 4, may involve low blood pressure, low oxygen levels, organ dysfunction, and rarely, life-threatening systemic inflammation. Moderate to severe CRS is commonly treated with tocilizumab, an IL-6 receptor blocking antibody, and corticosteroids to control the inflammatory response while preserving anti-cancer activity as much as possible.
At RGCIRC, all CAR-T patients are closely monitored for a minimum of seven to fourteen days after infusion for early signs of CRS. Tocilizumab and corticosteroids are available and administered promptly when clinically indicated.
Immune Effector Cell-Associated Neurotoxicity Syndrome
Immune effector cell-associated neurotoxicity syndrome, also known as ICANS, is a neurological side effect that may occur after CAR-T cell therapy. It has been reported in up to 50% of patients and usually develops within the first two weeks after infusion, often along with or after CRS.
Symptoms can range from mild confusion, difficulty finding words, and tremors to more severe problems such as encephalopathy, seizures, and, in rare cases, cerebral oedema. Mild cases are usually classified as Grade 1 to 2, while severe cases are classified as Grade 3 to 4.
ICANS often improves with corticosteroid treatment over days to weeks. At RGCIRC, a baseline neurological assessment is performed before infusion so that any post-infusion changes can be compared accurately. During the inpatient monitoring period, the clinical team closely observes patients for early neurological symptoms to ensure timely intervention.
Low Blood Counts and Infection Risk
Both conditioning chemotherapy and the immune activation caused by CAR-T therapy can suppress bone marrow function. This may lead to low blood counts, including reduced red blood cells, known as anemia; low white blood cells, known as neutropenia; and low platelets, known as thrombocytopenia.
These low blood counts may persist for weeks to months. Neutropenia can significantly increase the risk of bacterial, viral, and fungal infections during recovery. To reduce infection risk, RGCIRC provides care in HEPA-filtered isolation rooms that help minimise airborne exposure.
The hospital’s round-the-clock blood bank also supports transfusion requirements for anaemia and thrombocytopenia. Preventive antiviral, antifungal, and antibacterial medicines are prescribed routinely from the time of conditioning chemotherapy and continued until immune recovery.
Other Potential Side Effects
B-cell aplasia is an expected on-target effect of CD19-directed CAR-T therapy. This happens when healthy B-cells are eliminated along with CD19-positive cancer cells. As a result, some patients may develop low immunoglobulin levels, known as hypogammaglobulinaemia, which can persist for months to years and increase the risk of infections. Regular immunoglobulin replacement infusions may be required in such cases.
Tumour lysis syndrome is another possible complication. It occurs when cancer cells break down rapidly, releasing their contents into the bloodstream and causing metabolic disturbances. Patients are monitored closely, and preventive treatment may be given when required.
Haemophagocytic lymphohistiocytosis, or HLH, is a rare but serious inflammatory complication that can share features with severe CRS. It requires early recognition and specific management by the clinical team.
When to Contact Your Clinical Team
After discharge, patients and caregivers should contact RGCIRC’s Haemato-Oncology team immediately if any warning signs develop. These include fever above 38°C, confusion, difficulty speaking, unusual behaviour, change in mental clarity, severe or worsening headache, difficulty breathing, chest discomfort, inability to eat or drink, significant bleeding, or any symptom that feels unusual, rapidly worsening, or significantly different from what the care team described as expected.
A 24/7 emergency service is available at RGCIRC’s Rohini campus for all registered patients.
Recovery and Long-Term Care
Recovery after CAR-T cell therapy continues for several months and involves physical, immune, and emotional healing. While the acute treatment phase ends with hospital discharge, patients require close follow-up, infection prevention, nutritional support, and long-term monitoring in the months that follow.
Recovery Timeline
During the first one to four weeks after infusion, patients continue close outpatient monitoring with weekly clinic visits and blood tests. They are advised to stay within easy reach of RGCIRC and avoid crowded places or environments with a high risk of infection.
From months one to three, blood counts gradually begin to recover and energy levels usually improve, although significant fatigue is common during this period. Response assessment with imaging and, where required, bone marrow evaluation is usually performed around day 30 and day 90 to assess whether remission has been achieved.
Between months three and six, many patients notice gradual improvement in stamina and daily functioning as immune recovery continues. Preventive medicines may be tapered under clinical guidance. Beyond six months, long-term surveillance continues at intervals decided by the treating team.
Nutrition and Lifestyle
During the period of immune suppression after CAR-T cell therapy, patients are usually advised to follow a low-microbial diet to reduce the risk of foodborne infections. Raw and undercooked foods, including raw meat, seafood, unpasteurised dairy products, and raw sprouts, should be avoided.
Adequate hydration and protein-rich foods can support tissue recovery and immune rebuilding. As immune function improves over the following months, dietary restrictions may be gradually relaxed under medical guidance. At RGCIRC, clinical dieticians provide personalised nutritional advice as part of the post-CAR-T supportive care pathway.
Returning to Daily Activities
The timeline for returning to work, study, or regular daily activities depends on how each patient recovers. Patients with uncomplicated recovery may be able to resume light desk-based work or study within three to four months of infusion.
Strenuous physical activity should be avoided until blood counts normalise and the treating team provides clearance, usually around the three to six-month assessment. Driving is generally resumed four to six weeks after infusion, once neurological monitoring confirms there are no ongoing ICANS-related symptoms and the patient is no longer taking sedating medicines.
International travel is usually not recommended for the first three to six months because of infection risk and the need to remain close to the treating centre during early immune recovery.
Long-Term Monitoring
Long-term follow-up after CAR-T cell therapy includes regular imaging, such as CT scans and, in selected cases, PET-CT scans, to monitor treatment response and detect early signs of recurrence. Bone marrow biopsy may be performed when clinically indicated.
Immunoglobulin levels are also monitored regularly. Intravenous or subcutaneous immunoglobulin replacement may be continued for as long as levels remain low. CAR-T cell persistence testing may be used to assess whether engineered cells are still present in the blood and to help interpret any later disease changes.
Surveillance for late effects, including secondary malignancies, continues as part of the long-term follow-up protocol. RGCIRC’s Haemato-Oncology team provides structured long-term follow-up for CAR-T patients through the BMT survivorship programme.
Emotional and Psychological Support
CAR-T cell therapy can be emotionally challenging for patients and families. The intensity of treatment, uncertainty of response, long recovery period, and fear of recurrence after remission can all create significant psychological stress.
RGCIRC’s Psycho-Oncology Department provides individual counselling, family support, group therapy, and crisis coordination for haematology patients throughout treatment and recovery. This support recognises that emotional and psychological wellbeing is an important part of cancer care, not an optional addition.
Why Choose RGCIRC for CAR-T Cell Therapy in Delhi?
Choosing the right centre for CAR-T cell therapy is an important decision for patients with relapsed or refractory blood cancers. The experience of the clinical team, specialised infrastructure, ability to manage complications, and access to long-term supportive care all play an important role in treatment safety and outcomes.
Established CAR-T Programme Led by Experienced Specialists
RGCIRC’s CAR-T cell therapy programme is among the most established in India. It is led by Dr Dinesh Bhurani, Head of Haemato-Oncology and Bone Marrow Transplant, who has conducted the highest number of CAR-T procedures in Northern India across adult and paediatric patients and multiple cancer indications. This experience is especially important in CAR-T therapy, where timely recognition and management of complications such as CRS and ICANS require specialised clinical expertise.
Dedicated BMT Infrastructure for CAR-T Care
CAR-T therapy at RGCIRC is delivered within the institute’s dedicated Bone Marrow Transplant infrastructure. The 22-bedded HEPA-filtered BMT Unit provides a protected environment for immunocompromised patients, while the round-the-clock blood bank supports urgent transfusion needs for anaemia and thrombocytopenia. The programme is also supported by dedicated haemato-pathology and molecular laboratories for disease monitoring before, during, and after treatment.
Adult and Paediatric CAR-T Treatment
Both adult and paediatric patients are evaluated for CAR-T cell therapy at RGCIRC. Paediatric cases are managed by the Paediatric Haematology and Oncology service in close coordination with the adult BMT unit, ensuring that treatment planning, supportive care, family counselling, and long-term follow-up are tailored to the needs of younger patients and their families.
Multidisciplinary Tumour Board Review
Every CAR-T candidate at RGCIRC is reviewed by the Haemato-Oncology Multidisciplinary Tumour Board before treatment is approved. The team includes haematologists, transplant physicians, medical oncologists, radiation oncologists, intensivists, infection control specialists, and psycho-oncologists. This collaborative review helps confirm whether CAR-T is the right option, optimise bridging therapy, plan safety precautions, and prepare the complete treatment pathway before the process begins.
Strong Foundation in Complex Haematological Care
RGCIRC’s CAR-T programme is built on the foundation of its long-standing BMT programme, which has performed approximately 1,000 bone marrow transplants since it began in 2000. This experience in complex haematological care supports the safe delivery of advanced cellular therapies and the management of patients who require intensive monitoring, infection prevention, transfusion support, and long-term surveillance.
Accreditation, Recognition, and Accessible Cancer Care
RGCIRC holds NABH accreditation, NABL accreditation for laboratory and diagnostic services, Green OT certification by Bureau Veritas, and NABH Nursing Excellence certification. The institute has also been recognised among the World’s Best Specialised Hospitals by Newsweek in 2024 and 2025, ranked No. 1 in North India for single specialty hospitals by The Times of India in 2025, and awarded Best Oncology Hospital of the Year 2026 by the IHW Council.
As a not-for-profit institution, RGCIRC also works to make advanced cancer care more accessible through its Philanthropy Department, which extends financial aid and subsidised care to eligible patients. Since 1996, RGCIRC has treated more than 3.5 lakh patients from India and across the SAARC region, guided by the belief that financial circumstances should not prevent access to specialist cancer care, including advanced cellular therapies.
Book a Consultation at RGCIRC
If you or a family member has been diagnosed with a blood cancer that has relapsed or not responded to previous treatment, the Haemato-Oncology and Bone Marrow Transplant team at RGCIRC can assess whether CAR-T cell therapy may be suitable for your condition.
To book a consultation, visit www.rgcirc.org or book online at care.rgcirc.org. You can also download the RGCI Care app on iOS or Android.
For appointments, call +91-11-4702 2222 for Rohini or +91-11-4582 2222 for Niti Bagh, South Delhi.
OPD Hours: Monday to Saturday, 9:00 AM to 5:00 PM
Emergency Services: Available 24×7 at both campuses
Frequently Asked Questions
Myeloma/ Multiple Myeloma
Myeloma or Multiple Myeloma are same things and is a cancer arising from plasma cells. Plasma cells too are very important component of body’s immune system and reside in bone marrow. Myeloma can cause widespread damage in body including bone weakness or fractures, kidney dysfunction, infections and anemia. Diagnosis of Myeloma depends upon bone marrow tests or a biopsy from affected tissue apart from several blood tests. Treatment of Myeloma consists of chemotherapy or certain targeted immunotherapies and Autologous bone marrow/ hematopoietic stem cell transplantation. With appropriate therapy, a significant number of patients can achieve good disease control and lead a near normal life.