HOW TO PREPARE FOR
CAR-T TREATMENT IN CHINA
Medical fitness, infection screening, document preparation, visa, and logistics โ everything an international patient needs to arrive in China ready for leukapheresis.
analyticsAt a Glance
- check_circleMedical fitness assessment must confirm ECOG 0โ1 and organ function adequacy before centres commit to a slot
- check_circleInfection screening (HBV, HCV, HIV, CMV, EBV) is mandatory โ active infections must be resolved before CAR-T
- check_circleFull document package including bone marrow biopsy, immunophenotyping, and prior treatment records must be translated
- check_circlePlan for 6โ8 weeks in China from leukapheresis through infusion and post-infusion monitoring
Medical Fitness Assessment
Before any Chinese CAR-T centre confirms a leukapheresis slot, your treating team will require evidence of adequate physical fitness and organ reserve. These are the standard parameters assessed.
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Performance Status
ECOG performance status 0โ1 (or Karnofsky Performance Score โฅ70) is required by virtually all centres. ECOG 2 is considered case-by-case and may be acceptable for paediatric or rapidly-deteriorating ALL patients.
- 2
Cardiac Evaluation
Echocardiogram with left ventricular ejection fraction (LVEF) โฅ50% is required. Patients with recent cardiac events, arrhythmias, or known cardiomyopathy require cardiology clearance.
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Organ Function Panel
Serum creatinine โค1.5ร ULN (or CrCl โฅ50 mL/min), ALT โค5ร ULN, total bilirubin โค2ร ULN, adequate bone marrow reserve (unless aplastic due to disease). Values must be from within 2โ4 weeks of assessment.
- 4
Pulmonary Function
Oxygen saturation โฅ92% on room air. Patients with significant COPD, pulmonary fibrosis, or recent pneumonia require pulmonary function testing.
- 5
CNS Status
Absence of active CNS disease is required for most protocols. Patients with prior CNS involvement must have documented clearance on CSF analysis. Some ICANS risk-stratification protocols require a baseline neurological assessment.
Mandatory Infection Screening Panel
Active infections must be identified and managed before leukapheresis. Uncontrolled infection is a contraindication to CAR-T. The following panel is standard across major Chinese CAR-T centres.
| Pathogen | Test Required | Significance if Positive |
|---|---|---|
| HIV | HIV-1/2 Ab/Ag (4th gen) | Active HIV generally excludes standard protocols; some centres have dedicated HIV+ CAR-T trials |
| Hepatitis B (HBV) | HBsAg + HBcAb (IgG and IgM) + HBV DNA if HBcAb positive | HBsAg+ requires antiviral prophylaxis (entecavir); HBcAb+ requires HBV DNA monitoring |
| Hepatitis C (HCV) | HCV Ab + HCV RNA if Ab positive | Active HCV replication requires treatment and clearance before CAR-T |
| Cytomegalovirus (CMV) | CMV IgG + IgM; CMV PCR if IgM positive | Active CMV viraemia must be treated with ganciclovir/valganciclovir before infusion |
| Epstein-Barr Virus (EBV) | EBV VCA IgG + IgM; EBV DNA PCR if recent acute infection suspected | Active primary EBV infection excludes immediate infusion |
| HTLV-1/2 | HTLV-1/2 Ab serology | Positive serology requires specialist review; generally excludes certain T-cell modification protocols |
| Tuberculosis (TB) | IGRA (QuantiFERON) or Mantoux + CXR | Latent TB requires INH prophylaxis before immunosuppression; active TB excludes CAR-T |
Document Preparation
Chinese CAR-T centres require a structured medical record package โ not just a referral letter. Documents must be translated into Chinese (CancerFax handles this) and organised by category.
Biopsy and Immunophenotyping
Full bone marrow biopsy report with immunophenotyping confirming CD19 expression (for B-cell malignancies) or BCMA/CD38 expression (for myeloma). The target antigen confirmation is non-negotiable โ centres will not proceed without it.
NGS and Flow Cytometry
Next-generation sequencing panel and multiparametric flow cytometry results confirming antigen density and disease burden. For ALL, cytogenetics (Philadelphia chromosome, MLL rearrangement) influence product and protocol selection.
Prior Treatment Records
Complete treatment history documenting all prior lines, responses, dates of relapse, and cumulative anthracycline dose. Most CAR-T protocols require confirmation of โฅ2 prior lines (or 1 line with specific high-risk features).
Recent Staging Scans
PET-CT or CT-based staging within 4โ8 weeks. Baseline disease burden and site distribution help the team plan lymphodepletion intensity and post-infusion monitoring intervals.
Bridging Therapy During Manufacturing
CAR-T manufacturing takes 3โ6 weeks after leukapheresis. Many patients with active disease require bridging therapy during this period to control disease burden without compromising the collected T-cells.
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Assess Disease Velocity
If disease is indolent or in partial remission, bridging may not be needed. Rapidly proliferating disease or bulky lymphoma typically requires bridging to prevent deterioration during the manufacturing window.
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Choose Bridging Regimen
Low-intensity regimens are preferred to avoid depleting or exhausting T-cells in the manufactured product. Options include bendamustine, steroids, intrathecal methotrexate, or low-dose polatuzumab in B-cell malignancies.
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Washout Before Lymphodepletion
A washout period of at least 2โ4 weeks after the last bridging dose is typically required before starting fludarabine/cyclophosphamide lymphodepletion to avoid interference with CAR-T expansion.
Logistics: Visa, Accommodation, and Duration
International patients travelling to China for CAR-T should plan a minimum 6โ8 week stay from leukapheresis to the end of the post-infusion acute monitoring period. Advance logistics planning prevents last-minute disruptions.
M Visa (Medical Treatment Visa)
International patients travel on an M visa (commercial/business) or a medical treatment letter-supported tourist visa depending on consulate requirements. CancerFax prepares the hospital invitation letter and medical certification required for the visa application. Processing time is typically 5โ15 business days.
Staying Near the Hospital
Most CAR-T centres are in Beijing (Haidian/Dongcheng district โ near Peking University Third Hospital, PUMCH, Xuanwu) or Shanghai (Xuhui/Jiading โ near Ruijin Hospital, Renji). Budget service apartments within 2โ3 km of the hospital are recommended for the companion. Some hospitals have affiliated patient housing.
Family Companion
1โ2 family companions are strongly recommended. The patient will be inpatient for 2โ4 weeks and may be incapacitated during CRS or ICANS. The companion manages accommodation, communicates with the hospital via CancerFax interpreter, and coordinates discharge planning.
Total China Stay: 6โ8 Weeks
Week 1โ2: pre-infusion workup and leukapheresis. Weeks 2โ5: manufacturing wait (bridging if needed, outpatient or return home if distance allows). Week 6: lymphodepletion (3โ5 days inpatient). Week 6โ8: CAR-T infusion and post-infusion monitoring (minimum 4 weeks inpatient or near-hospital).
More from the CAR-T in China Resource Library
Continue exploring the complete CAR-T treatment guide โ from the main overview to preparation and process topics.
Frequently Asked Questions
Common questions from international patients preparing for CAR-T treatment in China.
Can I return home during the manufacturing wait?
In some cases, yes โ if you are medically stable, disease is controlled, and the flight is under 8โ10 hours. The decision depends on your treating team's assessment of disease velocity and bridging needs. If bridging therapy is required, it is usually administered in China during the manufacturing period. CancerFax coordinates both scenarios โ China-stay or interim return โ with the treating centre.
What if my CD19 expression is low or heterogeneous?
Low or dim CD19 expression (below 20% of blast population) may reduce CAR-T efficacy and is flagged by centres during eligibility review. Some centres accept cases with โฅ10% CD19 expression; others require โฅ50%. Heterogeneous expression is a relapse risk factor. Alternative targets (CD22, bispecific CD19/CD22 constructs) are available at some centres. CancerFax identifies which centre's protocol best fits your antigen profile.
How long before travel do I need to start preparing documents?
Allow at least 3โ4 weeks for full document preparation including translation, re-staining requests, and NGS result retrieval if not already available. Visa processing adds another 2โ3 weeks. CancerFax recommends starting the preparation process as soon as a decision to pursue CAR-T is made โ ideally 6โ8 weeks before intended travel.
Is a bone marrow biopsy always required before travel?
Yes, for all B-cell malignancy CAR-T protocols, a recent bone marrow biopsy (within 4โ8 weeks) with immunophenotyping confirming CD19 expression is mandatory. Chinese centres will not confirm a leukapheresis slot without this. For myeloma BCMA CAR-T, a bone marrow biopsy confirming BCMA expression and plasma cell percentage is similarly required.
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.
Start Your CAR-T Eligibility Review with CancerFax
CancerFax reviews your records before you travel, confirms medical fitness, identifies gaps in your screening panel, and prepares the complete document package your Chinese hospital requires.
This content is for informational purposes only and does not constitute medical advice. All fitness assessments must be performed and interpreted by qualified medical professionals.