Consultant, Haemato-Oncology & BMT, Fortis Hospital, Shalimar Bagh, New Delhi
Part 4 of 8 in CAR-T Cell Therapy
Who Is Eligible for CAR-T Cell Therapy?
September 6, 2026
CAR-T cell therapy is still a fast-evolving field, and its approved uses in India today are narrower than where the therapy is ultimately headed. Dr. Akash Khandelwal set out exactly which patients qualify right now.
Two approved indications, from age 15
CAR-T is currently approved only for patients aged 15 and above, for two indications: relapsed or refractory B-cell lymphoma, which includes marginal zone lymphoma, follicular lymphoma, mantle cell lymphoma and diffuse large B-cell lymphoma, and relapsed or refractory B-cell acute lymphoblastic leukaemia. As more trials proceed in India, Dr. Khandelwal expects more approved indications over the coming months and years.
For patients who have run out of other options
CAR-T is used in patients who have relapsed after a bone marrow transplant, or who are unfit for a bone marrow transplant in the first place. For this group, many of whom would otherwise be moving toward palliative care with nothing much left to offer, CAR-T provides a genuine and potentially life-changing chance of cure rather than just a raise of hope.
Why the target matters: CD19 and B-cells
Both CAR-T products available in India target CD19, a marker responsible for the B-cell response. That makes B-cell acute lymphoblastic leukaemia and B-cell lymphoma the right targets. Burkit lymphoma is not, because it needs a different CAR-T construct, and CNS lymphoma, while it can be tried, does not respond as well as the approved indications.
This article is based on a Jivo Masterclass session conducted by Dr. Akash Khandelwal, Consultant, Haemato-Oncology & BMT, Fortis Hospital, Shalimar Bagh, New Delhi. The article has been summarised with the assistance of an AI tool from the original masterclass recording. Watch the full Masterclass recording
This guide is based on a live Jivo Masterclass: Dr. Akash Khandelwal taught doctors across Africa on March 9, 2025.
FROM THE LIVE Q&A
Dr. Dimah Prince Ishmael (Ghana)
Do you have specific nutritional considerations for patients undergoing CAR-T cell therapy, especially in a setting with very limited access to CAR-T treatment centres?
Dr. Akash Khandelwal
Adequate T-cell collection is the rate-limiting step for CAR-T, and nutrition can affect that. If enough T-cells aren't collected, the only option is to wait and reattempt collection after about 6 months. Beyond that, nutrition doesn't play a major role, since the chemotherapy used for CAR-T is not very toxic and even a frail patient can undergo CAR-T therapy. Nutrition plays a bigger role in bone marrow transplants than it does in CAR-T cell therapy.
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Frequently Asked Questions
Can you elaborate further on the vein-to-vein time you mentioned, around 19 days: how exactly are the cells collected and processed before the transplant?▼
T-cells are collected the same way a stem cell or single-donor platelets are collected, through an apheresis machine. No drugs are given before collection; a vein is all that's needed, and if an adequate number of T-cells is found, CAR-T manufacturing can go ahead.
Is there any risk to hair regrowth after the chemotherapy and CAR-T treatment?▼
The conditioning chemotherapy is just cyclophosphamide and fludarabine, which can cause cytopenias and neutropenia, but this is manageable since the dosing isn't very high, so fitness is not usually a major factor. It's the CAR-T related side effects that vary more from patient to patient. If the disease is well controlled going in, complications are less likely, but even with good control, side effects such as cytokine release syndrome or, less commonly, ICANS (which can affect the brain) can occur. Whatever side effects arise are manageable and not life-threatening: no deaths from CAR-T related side effects have been seen, and it isn't well documented even in the long-term data.
What are the specific cancer cells targeted by CAR-T, and can it be applied to ovarian or cervical cancers?▼
Not yet - it hasn't shown good promise there so far. Currently CAR-T is only available for B-cells, targeting CD19, and this has shown long-term responses based on research done in the US, with a large subset of patients still in remission after CD19-targeted CAR-T infusion. Other categories are in development too, such as dual-target CARs and attachments that help CAR-T expand and persist for longer, but currently only CD19 CAR-T can be offered, since that's what's commercially available in India.
Where do you see CAR-T cell therapy heading in other cancers?▼
CAR-T cells are likely to become a first-line option in almost all cancers within the next 5 to 10 years. If it doesn't get there, that would actually be a missed opportunity, because it targets cells in a very different and unique way. More and more data is showing increasing promise for the treatment.
If possible, could you share your slides with us so we can go through the presentation again?▼
Yes, no problem: the slides will be shared after the session.
Who is currently eligible for CAR-T cell therapy in India?▼
Patients aged 15 and above with relapsed or refractory B-cell lymphoma (marginal zone, follicular, mantle cell or diffuse large B-cell) or relapsed or refractory B-cell acute lymphoblastic leukaemia.
Is CAR-T only used after a failed bone marrow transplant?▼
It is used both in patients who have relapsed after a bone marrow transplant and in patients who are unfit for one in the first place.
Does CAR-T work for all lymphomas?▼
No. It targets CD19, so it works for B-cell lymphomas, but not for Burkit lymphoma, which needs a different construct, and it does not respond as well in CNS lymphoma.
In This Series: CAR-T Cell Therapy
- 1.CAR-T Cell Therapy
- 2.What Is CAR-T Cell Therapy and How Does It Work?
- 3.The CAR-T Cell Therapy Timeline: From Collection to Infusion
- 4.Who Is Eligible for CAR-T Cell Therapy?
- 5.Managing Complications After CAR-T Cell Infusion
- 6.CAR-T Cell Therapy Outcomes: What the Data Shows
- 7.The Cost and Availability of CAR-T Cell Therapy in India
- 8.The Future of CAR-T Cell Therapy: Beyond Lymphoma and Leukaemia