Overview by Dr. Francesca Lorraine Lim discussed the development of CAR-T cell therapy at Singapore General Hospital (SGH). The information was shared during the 6th EBMT conference in 2024.

Progress in CAR-T therapy Key Milestones:

  1. 2017 - Initial Recognition and Resource Allocation:
    o After FDA approval of commercial CAR-T therapies, Singapore allocated resources to develop clinical teams and trial units.
  2. 2019 - Participation in Clinical Trials:
    o SGH participated in pivotal clinical trials, gaining experience with the logistics and patient selection for cell and gene therapies.
  3. March 2021 - Regulatory Approval:
    o Health Science Authority approved the use of Kymriah for third-line treatment.
    o This period also saw the establishment of relevant regulations.
  4. March 2022 - Academic CAR-T Program Initiation:
    o SGH launched an academic CAR-T program to address accessibility concerns.
    o The Minister of Health formed a team to develop national policies for cell therapy programs.
  5. March 2023 - Approval of Yescarta:
    o Yescarta received approval for third-line use.
    o SGH established a national GMP (Good Manufacturing Practice) facility.


Program Development:

  • Integration with Stem Cell Transplant Program:
    o SGH's CAR-T cell program is integrated into its existing stem cell transplant program.
    o The program was renamed to the Hematopoietic Cell Therapy and Transplant Program.
  • In-house Capabilities:
    o SGH has accredited apheresis facilities and comprehensive processing and storage capabilities.
    o The hospital started using commercial CAR-T therapies in 2021, alongside its academic program launched in 2022.


Current Clinical Program:

  • Commercial and Academic CAR-T Therapies:
    o SGH offers Kymriah and Yescarta for third-line treatment.
    o Participation in Novartis clinical trials for BCMA CARs.
    o Academic CAR-T program includes CD19 and dual construct autologous CAR-T therapies, manufactured using point-of-care project machines.
  • Case-by-case Eligibility:
    o Patients not meeting academic trial criteria may still receive treatment based on individual assessments and discussions with the clinical team.

Total cases as of December 2023: 39 cases.

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