HOW TO PREPARE FOR
CAR-T THERAPY IN INDIA

CAR-T is a demanding treatment. Patients must meet minimum organ function, performance status, and infection screening criteria before the Indian centre will accept a case.

• Performance Status

  ECOG performance status 0–1 (or Karnofsky Performance Scale ≥70%) is required. ECOG 2 patients are reviewed case-by-case. ECOG 3–4 patients are generally not eligible due to inability to tolerate CRS and ICANS management.

• Cardiac Function

  Echocardiogram with left ventricular ejection fraction (LVEF) ≥50% is mandatory. Cardiac dysfunction reduces tolerance to cytokine storm and the fluids used in CRS management.

• Renal and Hepatic Function

  Creatinine ≤1.5× ULN; ALT ≤5× ULN; total bilirubin ≤2× ULN. Active hepatic or renal impairment may require individual case review.

• No Active Infection

  Untreated active infection — bacterial, fungal, or viral — must be resolved before leukapheresis. Controlled, stable infections (e.g., HBV on suppressive antivirals) may be acceptable. The team will assess on a case-by-case basis.

All patients must complete a standard infection screen before the Indian centre confirms acceptance. These tests should be done in your home country to avoid delays on arrival.

• HIV, HBV, HCV

  HIV Ab/Ag, HBsAg, HBcAb (total), HCV Ab must all be done. HBV-positive patients may still be eligible with undetectable HBV DNA on entecavir or tenofovir suppression — discuss with the centre.

• CMV and EBV

  CMV IgG and IgM serology; EBV VCA IgG. CMV seropositive patients require weekly CMV PCR monitoring post-CAR-T. Results help stratify post-infusion surveillance intensity.

• TB Screening

  Tuberculosis screening with IGRA (QuantiFERON) or TST is required at most Indian centres — particularly for patients from high-TB-burden countries (South Asia, East Africa). Latent TB is manageable with prophylactic isoniazid.

• Blood Group and Crossmatch

  ABO/Rh blood group, direct Coombs test, and baseline crossmatch. Required for potential blood product support during aplasia.

Complete documentation prevents delays at the Indian centre. All records should be compiled and formatted before departure — CancerFax provides a structured summary service.

• Bone Marrow Biopsy with Immunophenotyping

  The most critical document. Must include: histology report with morphology, flow cytometry panel with CD19 expression percentage, cytogenetics (karyotype and FISH), and — if available — NGS molecular profiling.

• Prior Treatment Records

  All prior treatment lines documented: dates, drug regimens, response assessment, duration of response, reason for change. Each relapse must be separately documented with biopsy evidence.

• Imaging

  Most recent PET-CT or CT scan (within 4–6 weeks preferred). DICOM files on CD or USB — not just paper reports. The Indian centre will review imaging before accepting the case.

• Organ Function Tests

  CBC with differential, comprehensive metabolic panel (creatinine, LFTs, bilirubin), LDH, uric acid, ECG, and echo LVEF report. These should be done within 4 weeks of planned travel.

The 4–6 week manufacturing period between leukapheresis and infusion may be preceded by bridging chemotherapy if disease burden is high. This should be planned with your home physician.

1. 1

   Assess Disease Burden at Referral

   CancerFax reviews your imaging and bone marrow to assess whether disease is controlled enough to travel without bridging, or whether bridging is required first.

2. 2

   DLBCL Bridging Options

   For DLBCL with high disease burden: R-CHOP, R-GemOx, or R-mini-BEAM are commonly used bridging regimens. These should be administered in your home country before travel if possible — sparing India stay only for leukapheresis and infusion.

3. 3

   ALL Bridging Options

   For B-ALL: VCF (vincristine, cyclophosphamide, dexamethasone), hyper-CVAD part A, or mini-hyper-CVD. Blinatumomab can be used if CD19 is still positive and disease burden needs control.

4. 4

   Avoid Fludarabine and Clofarabine Before Leukapheresis

   These agents severely reduce T-cell counts and can impair leukapheresis yield. Ideally avoid within 4–6 weeks of planned leukapheresis.

5. 5

   Disease Assessment Before Departure

   Final CBC and disease assessment (imaging or bone marrow) within 2 weeks of planned travel to confirm fitness to proceed. CancerFax reviews and communicates this to the Indian centre.

Logistics for a 6–8 week stay in India require advance planning, especially for international patients travelling with a companion.

• Indian e-Medical Visa

  Apply at indianvisaonline.gov.in. CancerFax provides a hospital invitation letter from the treating centre — this is required for the visa application. Processing is typically 1–3 business days. Apply at least 2 weeks before travel to allow for any delays.

• Companion Travel

  One companion travelling on a medical attendant visa is strongly recommended. CAR-T patients should not travel alone due to the risk of sudden CRS or ICANS symptoms. The companion manages communication, medication, and emergency response.

• Accommodation Near TMC Mumbai

  For patients treated at TMC Parel, the Parel / Dadar / Lower Parel area has numerous guesthouses and service apartments priced Rs 1,500–4,000/night. CancerFax provides a list of vetted accommodation options with hospital proximity.

• Duration of Stay

  Plan for 6–8 weeks minimum: leukapheresis on arrival (day 1–3), manufacturing (4–6 weeks away from India or optional return home during manufacturing), lymphodepletion (3 days), infusion, and 2–3 weeks post-infusion monitoring.

Continue with related guides on the treatment timeline, costs, and how CancerFax helps with the entire process.

Frequently Asked Questions — Preparing for CAR-T in India