Ground-floor research explores quality of life after CAR T-cell therapy
Investigating the long-term effects of a new cancer treatment on patients is a lot like building a car while driving it. That’s the challenge faced by Hamilton Health Sciences (HHS) researcher and malignant hematologist Dr. Amaris Balitsky, who is studying the lasting impacts of CAR T-cell therapy, a specialized treatment that became available to Ontario patients with certain types of lymphoma just five years ago.
In 2020, the HHS Juravinski Hospital and Cancer Centre (JHCC) became the first hospital in Ontario to provide CAR T-cell therapy for patients with lymphoma, and the first hospital in Canada to offer this treatment on an outpatient basis. CAR T-cell therapy can knock lymphoma into remission, even for some patients previously considered incurable. But because the treatment is so new, it’s not yet understood what lies ahead for survivors, in terms of quality of life, in the months and years after treatment.
Balitsky’s research focuses on identifying long-term complications and offering solutions to help survivors enjoy the best quality of life.
“We’re learning from today’s patients, to hopefully help them have the best outcomes as well as building an improved quality of life for tomorrow’s patients.”
“Most patients want two outcomes from their treatment – to live longer and live better,” says Balitsky, a researcher with the Escarpment Cancer Research Institute, a joint institute of HHS and McMaster University, located at JHCC. “I want to ensure that when we treat a patient, we’re not only helping them live longer. We’re also supporting their desire for a good quality of life.”
How CAR-T therapy works
Traditionally, lymphoma treatment has involved some combination of radiation and chemotherapy. The addition of immunotherapy – which helps a person’s own immune system fight cancer — is a relatively new treatment option for most types of cancer including lymphomas, offering hope to many patients, including some who may previously have been considered incurable.
CAR T-cell therapy is an immunotherapy that involves changing a patient’s T-cells in a laboratory so they’ll attack cancer cells.
Managing side effects
As with many therapies, there’s a ripple effect. For example, CAR T-cell therapy creates a cytokine storm, which happens when the body releases chemicals called cytokines that can trigger a variety of symptoms, including inflammation of the brain.
“While we know that this brain swelling is mostly reversible, it’s also the side effect that patients are most concerned about,” says Balitsky, whose research is looking at whether such inflammation, even when short-term, can cause longer-term cognitive issues.
“CART-cell therapy is still so new that we don’t know what, if any, subtle, long-term complications may happen due to inflammation of the brain,” she says, adding, “While it’s exciting to have this new and lifesaving therapy, we need a better understanding of long-term side effects on survivors through research. For example, if there is reduced cognition, is there an intervention we can offer patients?”
In search of answers, Balitsky is recruiting 40 JHCC patients for an HHS Foundation-funded study looking at long-term cognition in lymphoma patients who receive CAR T-cell therapy. The first year of data is expected in January 2026.
This research involves performing a battery of cognition tests before treatment, and again one year after. “In addition, because everything’s intertwined, we’re also measuring patient-reported fatigue, depression and anxiety, and quality of life,” says Balitsky. Patients also self-report on whether they notice any changes in their cognition after treatment. That way, cognition test results can be compared with how patients perceive their ability to think clearly and retain information.
Compiling a registry of patients
Balitsky is also studying geography related to CAR T-cell therapy. “The JHCC is the only cancer centre in south central Ontario offering this therapy, so we’re treating patients from this region and beyond, including patients referred to JHCC from other hospitals who travel long distances for treatment here,” she says.
“Our study is looking at patients’ postal codes, their distance to JHCC, and any impact on outcomes. We don’t know, at this time, if there is any impact but we do know, for patients needing CAR T-cell therapy, it’s vital to move quickly.”
A CAR T-cell registry that Balitsky created and maintains is an important tool in supporting leading-edge research studies. For example, a study led by Balitsky that’s now complete and under review for publication used the registry to better understand the rate of secondary cancers following CAR T-cell therapy.
“We’re learning from today’s patients, to hopefully help them have the best outcomes as well as building an improved quality of life for tomorrow’s patients,” Balitsky says.
