B-cell cancers are a group of blood cancers that arise from abnormal B-lymphocytes. Learning about your specific diagnosis can help you have more informed conversations with your care team.
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Here you will find valuable information and resources that can assist you. CAR T-Cell Therapy is approved for the treatment of Relapsed / Refractory B-NHL & B-ALL. India’s first indigenous CAR-T therapy, developed at IIT Bombay.
You are not alone. This page is designed to help you and your family understand CAR-T cell therapy, what to expect during treatment, and the support available to you. Always speak with your doctor to understand what is right for you.
~1,00,000+
Annual estimated diagnosed cases of B-ALL & DLBCL in India
~40%
Patients with DLBCL experience relapse, of which many have refractory disease
<50%
of relapsed / refractory DLBCL patients in India have access to salvage treatment options (Real-world data, India)
Understanding B-cell cancers
1
What are B-cells?
B-lymphocytes (B-cells) are white blood cells that produce antibodies to fight infections. They are produced in the bone marrow and circulate through the lymphatic system and bloodstream.
2
What causes B-cell cancers?
A B-cell acquires genetic mutations that make it grow uncontrollably. These abnormal cells accumulate in lymph nodes, bone marrow, or blood - forming lymphomas or leukaemias.
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What does "relapsed or refractory" mean?
Relapsed means the cancer returned after a period of remission. Refractory means the cancer did not respond adequately to treatment. Both situations present additional challenges that your specialist can discuss with you.
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What happens when standard therapy hasn't worked?
When one or more lines of standard treatment have not achieved a lasting response, your haematologist may consider advanced treatment options including cell-based therapies.
Lymphoma is a cancer of the lymphatic system - the network of lymph nodes, vessels, and organs that help your body fight infection. About 90% of all lymphomas are Non-Hodgkin's Lymphoma (NHL). Most NHL cases are of B-cell origin (B-NHL).
Hodgkin's Lymphoma
Identified by Reed-Sternberg cells. Rarer (~10%), typically very responsive to first-line chemotherapy.
Non-Hodgkin's (B-NHL)
60+ subtypes. ~90% of lymphomas. Arises from B-lymphocytes - the focus of CD19-targeted therapies.
DLBCL
Diffuse Large B-Cell Lymphoma - most common aggressive B-NHL in adults
Lymph nodes, extranodal sites
PMBCL
Primary Mediastinal B-Cell Lymphoma - arises in the chest/thymus
Mediastinum; young adults
FL
Follicular Lymphoma - slow-growing; can transform to aggressive type (tFL)
Lymph nodes, bone marrow
MCL
Mantle Cell Lymphoma - involves the mantle zone of lymph nodes
Lymph nodes, GI tract, blood
MZL
Marginal Zone Lymphoma - affects the spleen, stomach, or lymph nodes
Spleen, MALT, lymph nodes
High-Grade B-NHL
Including double/triple-hit lymphomas with MYC, BCL2 or BCL6 rearrangements
Lymph nodes, extranodal
What all B-cell cancers share: CD19. Almost all B-NHL subtypes carry a protein called CD19 on their surface. CAR T-cell therapies are engineered to seek out and destroy cells carrying this marker. Speak with your doctor about whether this applies to your diagnosis.
In B-cell Acute Lymphoblastic Leukaemia, malignant B-cell precursors rapidly fill the bone marrow, spill into the blood, and can spread to the brain and spinal cord. Unlike B-NHL (which forms tumours in lymph nodes), B-ALL circulates through the bloodstream.
B-NHL (Lymphoma)
- Forms solid tumours in lymph nodes
- Lymphatic system disease
- Generally does not circulate freely in blood
- More common in adults over 50
- Treatment: chemo ± immunotherapy ± SCT
B-ALL (Leukaemia)
- Fills bone marrow; spills into blood
- Blood and bone marrow disease
- Can spread to CNS
- More common in children; adult B-ALL is aggressive
- Treatment: intensive chemo; SCT; CAR-T
Symptoms of B-ALL typically include: extreme fatigue, pallor, easy bruising or bleeding, frequent infections, bone and joint pain, and swollen lymph nodes. These arise because abnormal cells crowd out healthy blood cell production in the bone marrow.
CD19 in B-ALL: CD19 is expressed on approximately 85–90% of B-ALL cells, making it a strong target for CAR-T therapy. In relapsed or refractory B-ALL — where standard chemotherapy often fails — CAR-T therapies have shown meaningful activity. Ask your haematologist about all available options.
Understanding whether your cancer is relapsed or refractory matters because it affects which treatment pathways are available to you and your specialist's assessment.
Relapsed Cancer
Diagnosis
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Treatment
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Remission
→
Cancer returns
The cancer initially responded to treatment, but returned after a period of remission. The longer the remission, the more treatment options typically remain available.
Refractory Cancer
Diagnosis
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Treatment
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No response / Progression
The cancer never responded adequately to treatment. Primary refractory disease requires a fundamentally different therapeutic approach.
Why relapsed/refractory disease is challenging
- Multiple prior chemotherapy cycles may reduce bone marrow reserve
- Cancer cells may have developed resistance to standard drugs
- Cumulative toxicity limits further high-dose chemotherapy options
- Transplant may no longer be feasible depending on health status
What can happen next?
A specialist haematologist will review your case, including cancer type, prior treatments, and current health. They may recommend a clinical trial, a transplant (if eligible), a cell-based therapy like CAR-T, or a novel agent trial.
How Your Doctor Determines Eligibility
Eligibility for CAR T-Cell Therapy is determined by a haematologist or oncologist after a thorough clinical assessment. Here is a general overview of the key factors your doctor will consider.
Eligibility for advanced therapies is complex and highly individual. The information below is a general educational guide only. It should not be used to self-assess or to draw conclusions about your own treatment. Please consult a specialist haematologist or oncologist for a personalised evaluation.
Your Cancer Type
CAR T-cell therapy is approved for specific B-cell cancers. Your haematologist will confirm whether your specific cancer type and subtype fall within the approved indications. Not all B-cell cancers are currently covered
Prior Treatment History
Your treatment records will be reviewed to confirm the number and type of prior therapies received, and whether they resulted in lasting remission. Documentation from your previous oncology centre may be needed.
Current Health & Activity
Your doctor will evaluate your general fitness, ability to perform daily activities (performance status), and the health of key organs - including the heart, liver, and kidneys - to determine whether you can safely undergo treatment.
Cancer Marker Testing
CAR T-cell therapy targeting CD19 requires the presence of this protein on your cancer cells. A laboratory test, usually from a biopsy or blood sample, is typically required to confirm this before treatment can proceed.
Age
Some CAR T-cell therapies are currently approved for patients aged 15 years and above, while others have different age thresholds. Your specialist will confirm the applicable age criteria for your specific situation.
Infection & Other Tests
Screening for certain infections and assessment of blood count parameters are standard parts of the eligibility workup. Your clinical team will arrange these tests and explain the results to you.
Important: This list is for educational awareness only. The approved indications, eligibility criteria, and clinical requirements for CAR-T therapy are determined by your treating haematologist/oncologist. Do not use this information to self-diagnose or to decide on treatment. Speak with a specialist.Your Treatment Journey, Step by Step
From your first consultation to the weeks after infusion, here is what the process typically involves. Your clinical team will guide you at every stage.
1
Specialist Referral
Your doctor (oncologist/hematologist) will assess whether NexCAR19 therapy is suitable for you. This includes reviewing your medical history, current condition, and performing necessary tests
Consultation
2
Cell Collection
Blood is drawn and your T-cells are separated by a specialised machine. This is a day-care procedure - similar to a blood donation but takes longer. You are awake throughout and can usually go home the same day.
Day procedure - 4 to 6 hours
3
Cell Preparation
Your cells are engineered at a specialised facility over several weeks. In the laboratory, your T-cells are modified to carry the CAR receptor. During this time, your doctor may continue treatment to control your disease if needed.
~3–4 weeks; you may receive bridging care
4
Pre-Infusion Chemotherapy
Before receiving NexCAR19, you will be given a short course of chemotherapy over a few days. This helps prepare your body and improves the effectiveness of the CAR-T cells. You will be admitted to hospital for this phase.
Typically 3 days in hospital
5
Infusion Day
The modified CAR-T cells are infused back into your body through an Intravenous(IV) drip. The infusion itself is usually completed within an hour. You will be closely observed by your medical team throughout.
Single infusion - usually under 1 hour.
6
Monitoring Period
You remain in hospital for close monitoring, then stay near the centre for at least 4 weeks with your caregiver. Your team will watch for side effects, particularly cytokine release syndrome (CRS) and neurological symptoms (ICANS).
Most important phase for your safety
Plan for 6–10 Weeks
From cell collection to the end of your monitoring period, plan for approximately 6–10 weeks near the treatment centre.
Arrange Accommodation
You and your caregiver must stay within 30 minutes of the hospital for at least 4 weeks after infusion. Many centres assist with lodging.
Financial Planning Early
Start early: Speak with the financial counsellors at the centre at your very first appointment. Assistance programmes exist and can take time to arrange.
⚠️ Important: This treatment journey is illustrative and may vary for each individual. The exact process and timeline will be determined by your treating oncologist/haematologist based on your disease progression, overall health, and other clinical parameters.
Common Questions About CAR-T Therapy
Answers to the questions patients and families most often ask when they first learn about CAR-T therapy. Always speak with your specialist for guidance specific to your situation.
No — CAR-T therapy is a fundamentally different type of treatment. Chemotherapy uses chemical drugs to kill rapidly dividing cells (including healthy ones). CAR-T therapy uses your own immune cells — T-cells — which are collected from your blood, re-engineered in a laboratory to recognise and kill cancer cells specifically, and then infused back into your body. A short course of chemotherapy (called lymphodepletion) is given a few days before infusion to prepare your immune system, but the CAR-T cells themselves are a living, targeted treatment.
The overall timeline is typically 6 to 10 weeks from your first assessment to infusion day. After cell collection, your cells are sent for preparation which takes approximately 3–4 weeks. You will then be admitted for conditioning chemotherapy and the infusion itself. After infusion, you remain in hospital for monitoring and must stay near the treatment centre for at least 4 weeks.
In many cases, yes — you can often return home or stay locally during the cell preparation phase (approximately 3–4 weeks). Some patients may need bridging therapy during this waiting period. Your oncologist will advise on the best plan for your specific situation.
Most patients describe leukapheresis as similar to a blood donation, but longer — typically 4 to 6 hours. Blood is drawn from a vein, passed through a machine that separates out your T-cells, and the remaining blood is returned to you. You may feel a cold or tingling sensation and some patients experience mild dizziness. Most people resume light activity the same day.
CAR-T cells themselves do not cause hair loss. However, the short course of conditioning chemotherapy given before your infusion can cause temporary hair thinning or loss in some patients depending on the drugs used. Any hair loss is usually temporary.
India's first CAR-T therapy is significantly more affordable than equivalent therapies globally — at approximately one-tenth of the international cost. Financial support programmes are available including bridge financing through Mango Sciences and philanthropic access through the ImmunoACT Foundation. Ask the financial counsellor at your authorised centre early in your journey.
CAR-T therapy is only available at authorised treatment centres that have trained staff, monitoring capabilities, and the necessary medicines to safely administer the treatment. ImmunoACT has a network of over 80 authorised hospitals across India. Speak to your current oncologist about a referral to the nearest authorised centre.
CAR-T therapy is specifically designed for patients whose cancer is relapsed (has returned) or refractory (did not respond adequately) to prior treatment. Whether you are eligible depends on your cancer type, overall health, and prior treatments — which a specialist haematologist at an authorised centre can assess. Do not self-exclude based on assumptions about your situation.
Have more questions? Your specialist haematologist/oncologist is your best source of personalised guidance.
Understanding Possible Side Effects
Like all treatments, CAR T-cell therapy can cause side effects. Your clinical team is trained to monitor for, manage, and treat these. You will never be alone in managing them.
Every authorised CAR T-cell treatment centre has trained staff and the necessary medicines to respond quickly. You will receive detailed written guidance before your infusion.
Fever
A high temperature is one of the most common early signs that the treatment is activating your immune system. This can be an early indicator of cytokine release syndrome (CRS). Your medical team will monitor your temperature closely and respond promptly if it rises.
How it is managed: medications to reduce fever and address the underlying immune response are given promptly.
Low Blood Pressure & Fatigue
Your body may respond strongly to the therapy, leading to tiredness and a drop in blood pressure. These can also be features of CRS. You may feel weak or lightheaded. IV fluids and other supportive measures are given as needed. Rest is important.
How it is managed: IV fluids, rest, and supportive medications as required.
Neurological Symptoms (Less Common)
In some patients, the treatment may affect the brain, leading to symptoms such as confusion, difficulty speaking or finding words, or headaches. This condition is called immune effector cell–associated neurotoxicity syndrome (ICANS). These symptoms are usually temporary and are closely monitored by your medical team, who are trained to recognize early signs and manage them promptly.
How it is managed: close neurological monitoring; medications are available to treat this if it occurs.
Reduced Immunity
The therapy affects both cancer cells and healthy B-cells, temporarily reducing your immunity. Your doctor may prescribe protective medications. Regular follow-up blood tests after discharge help monitor your recovery.
How it is managed: protective medications and scheduled follow-up blood tests.
Difficulty Breathing (Less Common)
In some cases, the immune response may affect breathing. This can be associated with CRS and may require oxygen support. This is one of the primary reasons close hospital monitoring following infusion is essential.
How it is managed: oxygen support and medications to address the immune response.
Changes in Blood Counts
Red cell, white cell, and platelet levels may drop temporarily after therapy. Your Medical team will monitor your blood counts regularly. Supportive treatments such as transfusions or growth factors may be given if levels fall significantly.
How it is managed: regular blood tests, transfusions, or supportive medications if needed.
When to Contact Your Medical Team Immediately
After infusion and during your monitoring period, contact your clinical team or go to the emergency department straight away if you notice: high fever (38°C or above), confusion or sudden difficulty speaking, difficulty breathing, a rapid or irregular heartbeat, or any symptom that worries you. Do not wait. Your clinical team will give you a 24-hour emergency contact number before you are discharged.
Your team is prepared. Every authorised CAR-T treatment centre has trained staff and the necessary medicines to manage side effects. You will receive detailed written information about what to watch for before your infusion. Ask your doctor as many questions as you need.
Important context: The side effects listed here are known possibilities - not certainties. Most are manageable when detected early. Your medical team will explain what to watch for, and you will be monitored closely in hospital. Your specific risk profile will be discussed with you before you consent to treatment. For detailed clinical safety information, healthcare professionals should refer to the prescribing information in our HCP section.
Real Stories of Hope
How do you prepare for the journey?
Being well prepared for each stage of treatment can ease the process for both patients and caregivers. Use the checklists below as a guide – your clinical team will provide personalised instructions.
Medical Records & Reports
- Insurance paperwork & cards
- Medical records including laboratory tests, chemotherapy reports, CT scans or bone marrow biopsy reports
- List & duration of prior treatments and responses to each
- List of current medications including doses
Before Cell Collection
- Stay well-hydrated and eat a light meal before attending
- Wear comfortable, loose-fitting clothing with easy access to both arms
- Arrange a caregiver to accompany you — the procedure takes 4–6 hours
- Arrange transport home - do not plan to drive yourself
Accommodation & Logistics
- Arrange accommodation within 30 minutes of the treatment centre for at least 4 weeks post-infusion
- Plan for approximately 6–10 weeks away from home in total
- Identify a dedicated caregiver who can stay with the patient throughout
- Ask your centre about accommodation options available for families
Financial Preparation
- Meet the financial counsellor at your centre at your very first appointment
- Gather all health insurance documents and understand your coverage
- Ask about bridge financing options through Mango Sciences
- Enquire about the ImmunoACT Foundation if you face financial hardship
During Monitoring
- Keep a reliable thermometer - check temperature at least 3 times daily
- Save your centre's 24-hour emergency number before discharge
- The patient must not drive for at least 8 weeks after infusion
- Take all prescribed preventive medications on time, every day
Mental & Emotional Readiness
- Write down your questions before each consultation and bring them along
- Ask your clinical team to walk you through each step before it happens
- Connect with other patient families who have been through CAR-T treatment
- Seek support for both patient and caregiver - the journey is a team effort
Hope Initiative
CAR-T therapy is a complex, multi-step journey. Our team is here to make sure nothing falls through the cracks – clinically, logistically, and financially. You don’t have to walk this path alone.
The Hope Initiative is India’s first comprehensive CAR-T support ecosystem, built by ImmunoACT to stand beside you at every step – from your first referral all the way through long-term follow-up. Financial support is one pillar. The ecosystem is the foundation.
The Hope Initiative is ImmunoACT’s commitment to ensuring that every eligible patient in India has access to safe, outcome-driven CAR-T therapy.
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Vein-to-Vein Navigation
Dedicated patient navigators coordinate your apheresis scheduling, manufacturing timelines, logistics, and infusion planning - so you can focus on what matters most.
End-to-end coordination02
Financial Support
Eligible patients can access bridge financing of up to ₹10,00,000 - disbursed directly to the hospital, repayable over 12 months at 0% interest. Our value-based rebate program provides outcome-linked safeguards if disease progresses or disease-related mortality occurs within the first 12 months.
0% interest · 12 months03
Emotional & Clinical Support
From the day of referral through years of follow-up, our teams provide emotional guidance, caregiver support, and structured pathway advice - because healing is more than treatment.
Support04
Long-Term Monitoring
Through ACT.360 - our structured monitoring platform - your outcomes are tracked over time, contributing to real-world evidence that improves care for every patient who comes after you.
Powered by ACT.360During Treatment
During Treatment
Planning & Considerations
Navigating your journey with strength and support
Treatment plan
Your treatment team will schedule a process for collecting white blood cells (leukapheresis), based on:
Disease burden: If it’s high, your doctor may plan CAR-T treatment alongside another therapy to reduce it first.
Timing of prior treatments: Since CAR-T uses your T-cells, previous immunotherapies or chemotherapies might impact their quality or quantity. Your doctor will time the collection and treatment to ensure the best T-cells are available to fight your cancer.
Considerations
The cell collection process happens at the treatment center.
It is a day-care procedure, and usually requires 4-6 hours.
It is recommended to wear loose-fitting clothing for the procedure.
ImmunoACT processes the Leukapheresis sample within 24 hours. The hospital will inform you when manufacturing is proceeding.
Precautions
Before receiving CAR-T, inform your physician about any medical issues, including if you have or have had
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Neurologic problems (such as seizures, stroke, or memory loss).
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Lung or breathing problems.
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Heart problems.
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Liver problems.
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Kidney problems.
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A recent or active infection.
All medications you are currently taking – including prescription, over-the-counter medicines, vitamins, and herbal supplements Autoimmune disease, Diabetes Mellitus, any other co-morbidity
Inform your physician if you are pregnant, planning to become pregnant, or breastfeeding. A pregnancy test may be required before starting treatment. CAR T-cell therapy is not recommended during pregnancy or breastfeeding, as no safety data is currently available for these situations.
For Caregivers
Your Presence Makes a Difference
Caregivers play an essential role in the safety and recovery of CAR-T patients. Understanding your responsibilities before treatment begins will make a real difference.
- Stay with them for at least 4 weeks near a certified healthcare facility, as advised by the treatment team.
- Monitor for side effects, including those the patient may not notice (refer to “Managing Side Effects” and “Important Facts about ImmunoACT” for details).
- Assist with daily activities and recovery, such as maintaining a healthy diet and clean surroundings.
- Provide transportation, as patients should not drive for at least 8 weeks post-infusion.
Partnered Hospitals
Our strong association with over 130 + leading cancer treatment hospitals in India ensures hassle-free treatment with our CAR-T cell therapies.
CAR-T Patient Information Guide
Essential information guide for CAR-T cell therapy for treating relapsed/refractory B-cell lymphomas and B-cell acute lymphoblastic leukemia.
This content is intended solely for informational and educational purposes. It shall not be interpreted as medical advice, a diagnosis, or a recommendation for any specific treatment. Before making decisions related to your health or medical care, please consult your treating physician or a qualified healthcare professional. Always seek guidance from a licensed medical expert for recommendations tailored to your personal medical condition and circumstances.
Individual results depend on numerous factors, including but not limited to medical history, the nature and severity of the condition, adherence to prescribed treatment, and the body’s response to therapy.
Individual results depend on numerous factors, including but not limited to medical history, the nature and severity of the condition, adherence to prescribed treatment, and the body’s response to therapy.