CAR-T TREATMENT
TIMELINE IN INDIA
From first consultation to safe discharge, the CAR-T journey in India typically takes 6โ8 weeks for international patients. Here is every step with real durations, what to expect, and how CancerFax supports you through each phase.
analyticsAt a Glance
- check_circlePre-evaluation and eligibility: 1โ2 weeks before travel
- check_circleLeukapheresis (T-cell collection): Day 0, 3โ5 hours outpatient
- check_circleNexCAR19 manufacturing: 3โ4 weeks from leukapheresis
- check_circleTotal India stay for international patients: 6โ8 weeks
The Full CAR-T Journey: Step by Step
Every step is described with the real time required. Plan your total India stay around 6โ8 weeks from leukapheresis to discharge. Pre-travel preparation adds 1โ2 weeks before arrival.
- 1
Phase 1: Pre-Evaluation (Before Travel, 1โ2 Weeks)
Share medical records, pathology reports, and recent imaging with CancerFax. The treating team confirms CD19+ disease, ECOG status, organ function, and absence of contraindications. Medical visa documentation prepared.
- 2
Phase 2: Arrival and Final Eligibility (Days 1โ5)
Patient arrives in India. Final blood tests, echocardiogram, PET-CT or CT staging, and clinical review at the treating centre confirm eligibility. Leukapheresis scheduled.
- 3
Phase 3: Leukapheresis โ Day 0
T-cell collection (leukapheresis) performed as a day procedure. 3โ5 hours, typically outpatient or a day unit admission. An IV catheter or temporary central line is used. Most patients go home or to their accommodation the same day.
- 4
Phase 4: Manufacturing Wait (Weeks 1โ4)
T-cells are transported to the ImmunoACT facility at IIT Bombay. Engineering, quality testing, and release takes 3โ4 weeks. Patients may return home during this period or remain in India. Bridging chemotherapy given to those with progressive disease.
- 5
Phase 5: Lymphodepletion (Days -5 to -3)
Patient re-admitted to hospital. Fludarabine and cyclophosphamide given over 3 days to deplete the immune system and create space for the CAR-T cells. Most patients tolerate this well. Mild fatigue and nausea are common.
- 6
Phase 6: CAR-T Infusion โ Day 0
NexCAR19 or Kymriah infused as a single 30โ60 minute IV infusion. The procedure itself is straightforward; the monitoring period that follows is the critical phase.
- 7
Phase 7: Inpatient Monitoring (Days 1โ28)
Patient remains admitted for 14โ28 days for CRS and ICANS surveillance. Daily clinical review, temperature monitoring, inflammatory markers (IL-6, ferritin, CRP). Tocilizumab biosimilar available for grade 2+ CRS.
- 8
Phase 8: Discharge and Follow-Up
Discharge once CRS resolved and patient tolerating oral intake. Outpatient follow-up at Day 30, Day 60, Day 90, 6 months, and 12 months. First bone marrow assessment typically at Day 28โ30.
Timeline at a Glance
- 3โ5 hrsLeukapheresis DurationT-cell collection procedure โ typically outpatient, Day 0.
- 3โ4 wksManufacturing TimeFrom leukapheresis to infusion-ready NexCAR19 product โ IIT Bombay GMP facility.
- 14โ28 daysInpatient MonitoringPost-infusion hospital stay for CRS and ICANS surveillance at the treating centre.
- 6โ8 wksTotal India StayRecommended minimum India stay for international patients from leukapheresis to discharge.
Timeline Comparison: NexCAR19 vs Kymriah in India
Both approved Indian CAR-T products follow a similar timeline. The key difference is centre and logistics coordination.
| Phase | NexCAR19 (ImmunoACT/TMC) | Kymriah (Immuneel/Apollo/Manipal) |
|---|---|---|
| Pre-evaluation | 1โ2 weeks (remote) | 1โ2 weeks (remote) |
| Leukapheresis | Day 0 at Tata Memorial Centre | Day 0 at Apollo / Manipal / Fortis |
| Manufacturing | 3โ4 weeks (IIT Bombay GMP) | 3โ4 weeks (Immuneel facility, India) |
| Lymphodepletion | Days -5 to -3, inpatient | Days -5 to -3, inpatient |
| Infusion | Day 0, 30โ60 minutes | Day 0, 30โ60 minutes |
| Inpatient monitoring | 14โ28 days post-infusion | 14โ28 days post-infusion |
| Total India stay | 6โ8 weeks | 6โ8 weeks |
| Day 28 response assessment | Bone marrow + MRD assessment | Bone marrow + MRD assessment |
Practical Planning for International Patients
Patients travelling from outside India need to plan accommodation, caregiver arrangements, insurance documentation, and visa. CancerFax handles most of this coordination.
Where to Stay During Manufacturing
Patients and caregivers can choose to remain in Mumbai or return home during the 3โ4 week manufacturing wait. TMC has associated guest houses and CancerFax can arrange nearby long-stay accommodation. Many international patients opt to return home and come back 10 days before infusion.
Caregiver Requirements
At least one adult caregiver is required to accompany the patient throughout treatment โ they will be the emergency contact and may need to make decisions on the patient's behalf during periods of CRS. Indian centres accept spouses, parents, siblings, or adult children as caregivers.
Medical Visa for India
International patients require an Indian medical visa (MV) โ not a tourist visa. CancerFax provides hospital invitation letters and treatment documentation to support visa applications. Medical visas are typically valid for 1 year with multiple entries, and can be renewed.
Post-Discharge Follow-Up Visits
Day 30 and Day 60 follow-up appointments typically require the patient to be in India or assessable locally. CancerFax can coordinate telemedicine follow-up with the treating team and local oncologist reporting to TMC for patients who return home between visits.
More from the CAR-T India Resource Library
Plan your full journey โ from eligibility to CRS management and cost breakdown.
- CAR-T Cell Therapy in India โ Complete Guide
- How to Prepare for CAR-T in India
- CRS Management at Indian CAR-T Centres: Tocilizumab Biosimilar Protocols
- CAR-T for B-Cell ALL in India: Paediatric and Adult Programmes
- CAR-T Cost Breakdown in India: What International Patients Pay
- How to Access CAR-T Cell Therapy in India via CancerFax
Frequently Asked Questions: CAR-T Timeline in India
Can a patient return home between leukapheresis and infusion?
Yes โ many international patients return home during the 3โ4 week manufacturing period rather than staying in India. This is feasible if the patient is medically stable and does not require bridging chemotherapy. The patient must return to India approximately 10 days before the scheduled infusion date to complete pre-admission workup, lymphodepletion, and infusion planning. CancerFax coordinates the return visit timing with the treating centre.
What is the discharge criterion after CAR-T infusion?
Discharge is typically permitted when: no active CRS grade 2 or above, patient is afebrile for at least 48 hours, tolerating oral medications and intake, and no neurological symptoms of concern. Most patients are discharged between Day 14 and Day 28 post-infusion. Patients with grade 3 CRS or any ICANS may have longer stays. Final discharge criteria are determined by the treating physician.
Can follow-up blood work be done in the patient's home country?
Yes. CancerFax provides a structured follow-up plan to the patient's local oncologist โ specifying what blood tests, bone marrow assessments, and imaging should be done at each time point (Day 30, 60, 90, 6 months, 12 months). Results are shared electronically with the TMC team for review. For B-ALL patients, MRD monitoring by flow cytometry may need to be performed at a specialist lab โ CancerFax can identify the nearest lab with this capability in the patient's country.
How CancerFax Helps
CancerFax is a specialist cancer access and patient-navigation platform. We help patients and families understand their options, organise medical records, coordinate hospital communication, and support cross-border treatment planning where appropriate.
We help collect and organise reports, scans, pathology, biomarker results, and treatment history for structured case review.
We communicate with hospitals or trial teams to assess whether a case may be suitable for further screening.
We support appointment coordination, document submission, translation, and direct communication with international departments.
For international patients, we help with practical coordination โ travel planning, hospital admission guidance, and local support.
If this option is not suitable, we help explore other relevant treatments, clinical trials, or advanced care pathways.
From inquiry through to follow-up, our coordinators provide a single point of contact for the family.
CancerFax does not guarantee treatment access, eligibility, or clinical outcome. Our role is to help patients access accurate information, structured review, and appropriate specialist pathways.
Ready to Plan Your CAR-T Journey to India?
CancerFax manages every step โ pre-travel records review, centre coordination, visa documentation, accommodation, and in-country support throughout treatment.
This content is for informational purposes only and does not constitute medical advice. Always consult a qualified oncologist before making treatment decisions.