Consultant, Haemato-Oncology & BMT, Fortis Hospital, Shalimar Bagh, New Delhi
Part 3 of 8 in CAR-T Cell Therapy
The CAR-T Cell Therapy Timeline: From Collection to Infusion
September 6, 2026
Patients considering CAR-T cell therapy often ask how long the whole process takes. Dr. Akash Khandelwal lays out a realistic minimum of around two months, from the first blood collection to discharge from the hospital after infusion.
Nineteen days of vein-to-vein time
The time from when T-cells are collected from the patient's own body to when the finished CAR-T product is programmed, expanded, quality controlled and returned for infusion is called vein-to-vein time, and it takes about 19 days.
Built-in flexibility if a patient isn't ready
Sometimes a patient's disease worsens during that 19-day window, or they pick up an infection that makes them temporarily unfit for infusion. In those cases, the infusion can be postponed for up to three months from the time of processing, since the manufactured CAR-T product remains cryopreserved and its quality holds up over that period. That flexibility lets the team choose the right timing and date for each patient rather than forcing infusion on a fixed schedule.
Chemotherapy, infusion, and the hospital stay
Before infusion, patients receive three days of lymphodepleting chemotherapy, from day minus 5 to day minus 3, followed by two days of rest before the CAR-T cells are infused. This chemotherapy clears space in the body so the CAR-T cells can expand once they arrive. Patients are then admitted for roughly 15 to 20 days after infusion so the team can watch for and manage complications early. Added together, this comes to an approximate minimum of 40 to 45 days for the complete process: about 19 to 20 days of manufacturing plus 20 to 25 days of hospital admission covering the pre-infusion chemotherapy and post-infusion monitoring.
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. Anh (Hong) Nguyen (Vietnam)
I also attend a gene and cell therapy conference in Vietnam, and my institution is developing its own academic clinical trial in CAR-T. Are there upcoming CAR-T trial opportunities in India that international patients could join?
Dr. Akash Khandelwal
Fortis Shalimar Bagh is in talks to run its own CD19-directed CAR-T clinical trial for lymphoma and leukemia. Myeloma CAR-T trials are also upcoming from other companies and should be commercially available in India by year end. However, international patients cannot be enrolled in Phase 1 or Phase 2 trials, since these require longer follow-up before DCGI grants approval based on long-term data for commercial or international use. Until then, the CD19 CAR-T that is already commercially available is the only option for international patients.
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Frequently Asked Questions
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?▼
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.
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.
What is vein-to-vein time in CAR-T cell therapy?▼
It is the time from T-cell collection to when the finished CAR-T product is ready for infusion, about 19 days.
Can CAR-T infusion be delayed if a patient isn't ready?▼
Yes. If the disease worsens or the patient develops an infection, infusion can be postponed for up to three months, since the manufactured CAR-T product stays viable when cryopreserved.
How long is the total CAR-T cell therapy process?▼
A realistic minimum of about two months, or roughly 40 to 45 days, covering manufacturing time plus the hospital admission for pre-infusion chemotherapy and post-infusion monitoring.
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