Oncology Revolution: Accessing CAR-T Cell Therapy in India’s Top Hospitals

Oncology Revolution: A New Era in Cancer Treatment Has Arrived

India has achieved a groundbreaking milestone in cancer care with the development and approval of indigenous CAR-T cell therapy, transforming previously untreatable blood cancers into potentially curable conditions. CAR-T (Chimeric Antigen Receptor T-cell) therapy represents one of the most revolutionary advances in oncology, reprogramming a patient’s own immune cells to recognize and destroy cancer cells with remarkable precision. With success rates ranging from 70-80% for relapsed or refractory blood cancers and costs as low as $48,000—compared to $400,000-500,000 in the United States—India is democratizing access to this life-saving treatment.

NexCAR19, India’s first homegrown CAR-T therapy developed through a decade-long collaboration between IIT Bombay and Tata Memorial Hospital, received approval from India’s Central Drugs Standard Control Organization (CDSCO) in October 2023. This achievement positions India as only the second country after the United States to develop indigenous CAR-T therapy, with at least 15 major hospitals across Delhi, Mumbai, Bangalore, Chennai, Hyderabad, and other cities now offering this transformative treatment.

Understanding CAR-T Cell Therapy: How It Works

The Science Behind the Revolution

CAR-T cell therapy works by harnessing the power of a patient’s own immune system to fight cancer. The treatment involves collecting T-cells (a type of white blood cell) from the patient’s blood through a process called leukapheresis, then genetically engineering these cells in specialized laboratories to express chimeric antigen receptors (CARs) on their surface. These CARs enable the modified T-cells to recognize and bind to specific proteins—most commonly CD19—that are abundantly present on the surface of cancerous B-cells.

Once the CAR-T cells are manufactured and expanded to therapeutic quantities (typically hundreds of millions of cells), they are infused back into the patient where they act as “living drugs”. The engineered cells actively seek out cancer cells throughout the body, bind to them, and trigger their destruction. Unlike traditional chemotherapy that must be administered repeatedly, CAR-T cells can persist in the patient’s body for months or even years, providing ongoing surveillance against cancer recurrence.

The Treatment Process Timeline

The complete CAR-T cell therapy journey typically follows this timeline:​

1. Patient evaluation and eligibility assessment (1-2 weeks): Comprehensive testing to confirm disease status, organ function, and suitability for treatment
2. Leukapheresis/T-cell collection (1 day): A 3-4 hour outpatient procedure to collect the patient’s T-cells
3. Manufacturing period (2-4 weeks): Cells are genetically modified and expanded in specialized cGMP facilities
4. Bridging chemotherapy (during manufacturing): Optional treatment to control disease while CAR-T cells are being produced
5. Lymphodepleting chemotherapy (3-5 days before infusion): Preparing the patient’s immune environment to receive CAR-T cells
6. CAR-T cell infusion (1 day): The engineered cells are administered intravenously, similar to a blood transfusion
7. Monitoring period (2-4 weeks hospitalization): Close observation for efficacy and management of potential side effects
8. Long-term follow-up (months to years): Ongoing monitoring for response durability and late effects

Rapid manufacturing innovations are reducing production times, with some next-generation CAR-T therapies being manufactured in as little as 24-72 hours compared to the current 2-4 week standard.​

India’s Indigenous CAR-T Therapies: NexCAR19 and Qartemi

NexCAR19: India’s First Homegrown CAR-T Therapy

NexCAR19 (Actalycabtagene autoleucel) represents a decade of collaborative effort between IIT Bombay, Tata Memorial Hospital, and the US National Cancer Institute. Developed by ImmunoACT, a spin-off company of IIT Bombay, this therapy became the first CAR-T cell treatment designed, manufactured, and approved in India in late 2023. The development journey included extensive collaboration with NCI scientists who provided training on manufacturing high-quality CAR-T cells suitable for human use and designing rigorous clinical trials.

Clinical Trial Results:

The pivotal clinical trial involved 60 patients with relapsed or refractory B-cell lymphomas and B-cell acute lymphoblastic leukemia (B-ALL) who had exhausted standard treatment options. The results were impressive:​

• Overall response rate (ORR): Approximately 70%​
• Complete remission rate: Varied by disease type, with B-ALL patients showing particularly strong responses
• Long-term cure rates: 40% for B-cell lymphoma patients at follow-up​
• Safety profile: Low levels of cytokine release syndrome (CRS) and notably no neurotoxicity, distinguishing it from other CD19-directed CAR-T therapies​

The initial trial phase included 14 patients with B-ALL, with the first patient receiving NexCAR19 infusion on June 4, 2021, at Tata Memorial Hospital in Mumbai—marking a historic moment for Indian oncology.​

Approved Indications:

NexCAR19 is approved for treating patients aged 15 years and above with:

• B-cell lymphomas (relapsed or refractory)
• B-cell acute lymphoblastic leukemia (B-ALL) (relapsed or refractory)

Manufacturing and Availability:

ImmunoACT manufactures NexCAR19 in a dedicated facility in Mumbai, with plans to establish additional manufacturing sites across India to increase capacity. The initial goal is to treat approximately 1,200 patients annually, with expansion planned as manufacturing capacity increases. The therapy is currently available at multiple hospitals across India, making it accessible to patients nationwide.

Qartemi: India’s Second Indigenous CAR-T Therapy

Qartemi, developed by Immuneel Therapeutics through technology transfer from Hemato Cellular Biotech (HCB), became India’s second commercially approved CAR-T therapy. This therapy is specifically designed for adult patients with relapsed or refractory B-cell Non-Hodgkin Lymphoma (B-NHL).

Key Innovations:

Immuneel has developed a patented SIM-CAR-T platform that enables production of both 3-day and 7-day CAR-T products, significantly accelerating manufacturing compared to traditional 2-4 week timelines. This rapid manufacturing approach addresses one of the critical challenges in CAR-T therapy—ensuring patients with aggressive disease can receive treatment before their condition deteriorates.​

Global Significance:

Qartemi represents the first global CD19-CAR-T product commercially approved in India, demonstrating the country’s capacity to not only adopt but also innovate in advanced cell and gene therapies.​

Cost Comparison: India’s Affordability Advantage

Dramatic Price Differences Globally

CAR-T cell therapy costs vary dramatically worldwide, with India offering the most affordable access to this revolutionary treatment:

Global CAR-T therapy costs:

• United States: $400,000-500,000 per treatment
• Europe: $350,000-450,000 per treatment​
• India (Indigenous NexCAR19): $36,000-50,000 (₹30-40 lakh)
• India (International CAR-T products): $68,000 average​
• India (Premium facilities): $150,000-250,000 for comprehensive packages​

The indigenous Indian CAR-T therapy represents approximately 1/10th the cost of therapies available in Western countries, making this previously inaccessible treatment financially feasible for a much broader patient population.

Why India Can Offer Lower Costs

Several structural factors enable India’s dramatic cost advantage:

1. Indigenous manufacturing: Local production eliminates international shipping, import duties, and currency exchange premiums
2. Lower operational costs: Reduced labor, facility, and infrastructure expenses compared to Western countries
3. Streamlined regulatory pathway: Efficient approval processes that reduce development costs
4. Academic-industry collaboration: Partnership between IIT Bombay and Tata Memorial Hospital eliminated profit-driven research costs
5. Scale potential: High patient volumes enable economies of scale in manufacturing
6. Government support: Initiatives promoting indigenous pharmaceutical and biotech innovation

Dr. Crystal Mackall from Stanford University, who served as an expert reviewer for the NexCAR19 trial, emphasized that lowering costs while maintaining quality represents “one of the holy grails” of CAR-T therapy development. India’s achievement in this area has global implications for making advanced cancer treatments accessible worldwide.

Value Proposition for International Patients

Even accounting for international travel, extended hospitalization, and accommodation expenses, international patients can save 60-75% by receiving CAR-T therapy in India compared to treatment in their home countries. For a patient facing $500,000 costs in the US, traveling to India for a $150,000-250,000 comprehensive package (including medical tourism support) still represents savings of $250,000-350,000.​

Success Rates and Clinical Outcomes

Overall Efficacy Data

CAR-T cell therapy in India achieves success rates ranging from 30-80%, with significant variation based on hospital quality, patient characteristics, and disease type. The most reputable facilities with specialized infrastructure and experienced teams report success rates at the higher end of this spectrum.​

Success rate breakdown by facility type:

• Premium hospitals with international accreditations: 70-80% for optimal patient profiles​
• Established cancer centers with CAR-T programs: 60-70% average
• Hospitals new to CAR-T therapy: 30-50% as programs mature​

Disease-Specific Outcomes

Different blood cancer types respond variably to CAR-T therapy:

B-cell Acute Lymphoblastic Leukemia (B-ALL):

• Overall response rate: 70-85%
• Complete remission rate: 60-70%
• Particularly effective in pediatric and young adult patients

Large B-Cell Lymphoma (LBCL):

• Overall response rate: 65-75%
• Complete remission rate: 50-60%
• Long-term cure potential: 40% at extended follow-up​

Follicular Lymphoma:

• Overall response rate: 70-80%
• Durable remission potential higher than aggressive lymphomas

Mantle Cell Lymphoma:

• Overall response rate: 60-70%
• Benefits patients with limited alternative treatment options

Factors Influencing Success

Several patient-specific and treatment-related factors significantly impact CAR-T therapy outcomes:

Patient factors:

• Age and overall performance status
• Disease burden at treatment time (lower burden correlates with better outcomes)
• Number and type of prior therapies
• Organ function adequacy
• Bone marrow reserve capacity

Treatment factors:

• Hospital expertise and experience with CAR-T therapy
• Quality of manufacturing facilities and processes
• Supportive care capabilities for managing side effects
• Timing of treatment (earlier in disease course generally improves outcomes)

Patient Eligibility Criteria for CAR-T Therapy

Who Qualifies for CAR-T Treatment

CAR-T therapy is available for specific patient populations with blood cancers that have relapsed after standard treatment or proven refractory (resistant) to conventional therapies. The eligibility criteria balance maximizing treatment potential while ensuring patient safety.

Key inclusion criteria:​

• Age requirement: Patients must be over 1 year old (NexCAR19 approved for 15+ years)
• Disease type: Relapsed or refractory B-lymphoproliferative disorders with CD19 expression​
• Prior treatment history: At least 1-2 lines of standard therapy attempted​
• Adequate organ function: Liver, kidney, heart, and lung function must meet minimum thresholds
• Performance status: Sufficient physical condition to tolerate intensive treatment
• Bone marrow reserve: Adequate baseline blood counts​

Key exclusion criteria:​

• Hyperleukocytosis: White blood cell count exceeding 50,000 cells/μL​
• Pregnancy: Pregnant or breastfeeding women cannot receive CAR-T therapy​
• Active infections: Hepatitis B, hepatitis C, or HIV infection​
• Major cardiac conditions: Recent heart attack, unstable arrhythmias, or severe heart failure​
• CNS disease: Uncontrolled central nervous system involvement may require special consideration​
• Recent major surgery or transplant complications​

Updated Treatment Guidelines

In 2023, eligibility criteria were expanded to allow patients with large B-cell lymphoma (LBCL) who have failed one or more lines of therapy to access CAR-T treatment earlier in their disease course. This change reflects growing evidence that earlier intervention with CAR-T therapy—before patients become heavily pretreated and weakened by multiple chemotherapy regimens—improves outcomes.​

Patients meeting these criteria should consult with hematologist-oncologists at CAR-T treatment centers for comprehensive evaluation and personalized assessment.​

India’s Top Hospitals Offering CAR-T Cell Therapy

Comprehensive National Network

As of 2026, at least 15-20 major hospitals across India offer CAR-T cell therapy, with capabilities ranging from basic programs to comprehensive centers with extensive experience. Geographic distribution ensures patients from all regions can access this treatment without extensive domestic travel.

Leading CAR-T Centers by Region

Delhi NCR Region:

• Max Healthcare (Delhi): Comprehensive oncology program with CAR-T capabilities
• Apollo Hospital (Delhi): Part of Apollo’s national CAR-T network
• Rajiv Gandhi Cancer Institute (Delhi): Specialized cancer center with CAR-T program​
• Fortis Memorial Research Institute (Gurugram): Advanced oncology infrastructure
• Medanta The Medicity (Gurugram): Multi-specialty support for complex cases
• Artemis Hospital (Gurugram): International-standard cancer care​
• Sarvodaya Hospital (Faridabad): Latest technologies for CAR-T therapy with 30+ years oncology experience
• Amrita Hospital (Faridabad): Launched Northern India’s first CAR-T program, treating B-cell lymphoma patients with 40% long-term cure rates​

Mumbai & Pune Region:

• Tata Memorial Hospital (Mumbai): Pioneering institution where India’s first CAR-T patient was treated; academic center with research focus
• Kokilaben Dhirubhai Ambani Hospital (Mumbai): State-of-the-art private facility​
• Jaslok Hospital (Mumbai): Established cancer care program​
• Apollo Cancer Centres (Navi Mumbai): Part of Apollo’s national CAR-T network; successfully completed commercial CAR-T programs

Bangalore Region:

• Manipal Hospitals (Bangalore): Multi-specialty capabilities supporting CAR-T therapy
• HCG Cancer Centre (Bangalore): Specialized oncology focus​
• Cytecare Hospital (Bangalore): Cancer-specific institution​

South India:

• Apollo Cancer Centres (Chennai, Hyderabad): Regional hubs in Apollo’s CAR-T network
• Amrita Hospital (Kochi): Kerala’s premier CAR-T center

Apollo Cancer Centres: India’s First Private CAR-T Network

Apollo Cancer Centres emerged as the first private hospital group in India to successfully complete commercial CAR-T cell therapy programs. The network began by treating patients with imported CAR-T drugs, gaining expertise before transitioning to Made in India therapies like NexCAR19.​

Dr. Anupam Chakrapani, Senior Consultant in Hematology & BMT at Apollo Cancer Centre Kolkata, noted that the successful treatment of three patients using CAR-T therapy at the commercial level “represents a significant leap forward in our fight against B-cell lymphomas and acute lymphoblastic leukemia”. Dr. Rajat Bhattacharyya, Senior Consultant in Pediatric Hematology, emphasized that this “represents a pivotal moment in the advancement of cancer treatment in India”.​

Apollo’s CAR-T program now operates across multiple locations including Navi Mumbai, Hyderabad, and Chennai, with plans for further expansion.

The CAR-T Treatment Journey: What to Expect

Initial Consultation and Evaluation

The CAR-T therapy journey begins with comprehensive evaluation at a specialized treatment center. This includes:​

• Detailed review of cancer diagnosis, staging, and treatment history
• Complete physical examination and performance status assessment
• Organ function testing (cardiac, pulmonary, hepatic, renal)
• Bone marrow evaluation
• Imaging studies to assess disease burden
• Infectious disease screening
• Psychosocial assessment and support planning

The multidisciplinary team—including hematologist-oncologists, CAR-T coordinators, transplant specialists, and critical care physicians—reviews all data to confirm eligibility and develop a personalized treatment plan.​

Leukapheresis: Collecting Your T-Cells

Once approved for CAR-T therapy, patients undergo leukapheresis—a specialized blood collection procedure. This outpatient process typically takes 3-4 hours, during which blood is removed through one arm, passed through a machine that separates and collects T-cells, and returned through the other arm. The collected cells are immediately transported to the manufacturing facility where they will be genetically modified.​

The Manufacturing Period: Bridging Therapy

While CAR-T cells are being manufactured—currently 2-4 weeks for standard processes, though rapid manufacturing can reduce this to 1-3 days—patients may receive bridging chemotherapy to control disease progression. This period requires close monitoring, as patients must remain stable enough to receive CAR-T infusion once manufacturing is complete.​

For patients with aggressive disease, manufacturing time represents a critical window where disease progression could make them ineligible for treatment—one reason India’s rapid manufacturing innovations are so important.

Lymphodepleting Chemotherapy

Three to five days before CAR-T cell infusion, patients receive lymphodepleting (conditioning) chemotherapy. This preparatory treatment creates an optimal immune environment for the incoming CAR-T cells by reducing existing lymphocytes and creating “space” for the engineered cells to expand and function effectively.​

CAR-T Cell Infusion Day

The actual CAR-T cell infusion is relatively simple—administered intravenously like a blood transfusion, typically taking 15-30 minutes. Patients are monitored closely during and immediately after infusion for any immediate reactions. Unlike chemotherapy, there is no immediate sensation or side effect from the infusion itself; the therapeutic effects and potential side effects emerge over the following days as the CAR-T cells expand and engage cancer cells.​

Monitoring Period: Managing Side Effects

Following infusion, patients require intensive monitoring for 2-4 weeks, typically as inpatients. The two primary concerns during this period are:​

Cytokine Release Syndrome (CRS): Occurs when CAR-T cells become activated and release large amounts of inflammatory molecules. Symptoms range from flu-like illness (fever, fatigue, muscle aches) to severe complications requiring intensive care. NexCAR19 demonstrates notably low CRS rates compared to other CAR-T therapies.​

Immune Effector Cell-Associated Neurotoxicity Syndrome (ICANS): Neurological side effects including confusion, difficulty speaking, tremors, or seizures. Remarkably, NexCAR19 showed no neurotoxicity in clinical trials—a significant safety advantage.​

Modern management strategies including the IL-6 inhibitor tocilizumab for CRS and corticosteroids for ICANS have dramatically improved the safety profile of CAR-T therapy.​

Long-Term Follow-Up

After discharge, patients require regular follow-up for months to years, monitoring for treatment response, disease recurrence, and late effects. Many patients achieve durable remissions lasting years, with some potentially cured of their cancer.

Infrastructure and Technology Requirements

What Makes a Hospital CAR-T-Ready

Not every oncology center can offer CAR-T therapy—specialized infrastructure and expertise are essential:​

Manufacturing facilities: cGMP-certified laboratories capable of genetically modifying and expanding T-cells under sterile conditions​

Advanced ICU capabilities: Critical care units equipped to manage CRS and ICANS complications​

Bone marrow transplant expertise: Many aspects of CAR-T care mirror transplant protocols and complications​

Leukapheresis equipment: Specialized machines for collecting T-cells from patients​

24/7 specialized staffing: Trained nurses, physicians, and support staff available around the clock​

Rapid response protocols: Systems for immediately addressing treatment-related complications​

Long-term follow-up systems: Mechanisms for monitoring patients for years after treatment​

Sarvodaya Hospital’s CAR-T Infrastructure

Sarvodaya Hospital in Faridabad exemplifies the technology and infrastructure approach of leading Indian CAR-T centers:​

• Latest technologies and facilities designed specifically for CAR-T therapy
• 30+ years of oncology experience informing treatment protocols
• Dedicated CAR-T care teams with specialized training
• Advanced monitoring systems for early detection of complications
• Comprehensive supportive care capabilities
• Patient and family education programs

The Future of CAR-T Therapy in India

Expanding Access and Reducing Costs Further

ImmunoACT’s initial goal of treating 1,200 patients annually with NexCAR19 represents just the beginning. As additional manufacturing facilities come online across India and more hospitals develop CAR-T programs, access will expand significantly. Competition between NexCAR19 and Qartemi, along with potential approval of additional indigenous CAR-T products, may drive costs even lower.

Next-Generation CAR-T Innovations

Indian researchers are already working on next-generation improvements:

Rapid manufacturing: Reducing production time from weeks to 1-3 days, enabling treatment of patients with aggressive disease before they deteriorate

Allogeneic (off-the-shelf) CAR-T: Using donor cells instead of patient’s own cells, eliminating manufacturing wait time entirely​

Dual-target CAR-T: Engineering cells to recognize multiple cancer proteins simultaneously, reducing escape mechanisms​

Solid tumor CAR-T: Extending beyond blood cancers to treat solid tumors like lung, breast, and ovarian cancer—currently in early research stages​

Global Impact and Model for Other Countries

India’s success with affordable CAR-T therapy has caught global attention as a potential model for other middle and lower-income countries. The collaborative approach between academic institutions (IIT Bombay), clinical centers (Tata Memorial Hospital), international partners (NCI), and commercial entities (ImmunoACT) demonstrates how innovative partnerships can overcome resource constraints to deliver cutting-edge therapies.

Dr. Crystal Mackall noted that India’s achievement in developing CAR-T therapy at 1/10th the cost while maintaining efficacy and safety represents “a big achievement” with implications far beyond India’s borders. Other countries are now studying India’s model to potentially replicate this success in their own healthcare systems.

Making the Decision: Is CAR-T Therapy Right for You?

When to Consider CAR-T

CAR-T therapy should be considered for patients with:

• B-cell lymphomas or B-ALL that have relapsed after initial treatment
• Disease that is refractory (resistant) to standard chemotherapy
• Adequate organ function and performance status to tolerate treatment
• CD19 expression confirmed on cancer cells
• Exhaustion of at least 1-2 lines of conventional therapy

Earlier consideration of CAR-T—rather than waiting until patients are heavily pretreated and weakened—generally improves outcomes.​

Questions to Ask Your Doctor

When considering CAR-T therapy at an Indian hospital, important questions include:

• How many CAR-T procedures has this center performed?
• What are your institution’s specific success rates for my cancer type?
• Which CAR-T product (NexCAR19, Qartemi, or imported) do you recommend for my case and why?
• What is the complete timeline from evaluation to infusion?
• What supportive care capabilities does your hospital have for managing complications?
• What will my total out-of-pocket costs be?
• What long-term follow-up will I require?

The Promise of CAR-T for Indian and International Patients

India’s CAR-T revolution offers genuine hope to patients with blood cancers who have exhausted conventional options. With 70-80% success rates for appropriate candidates, costs 80-90% lower than Western countries, and growing availability across major cities, this once-experimental therapy is becoming an accessible standard of care.

For international patients, the combination of world-class oncology expertise, cutting-edge CAR-T technology, comprehensive medical tourism support, and dramatic cost savings makes India an increasingly attractive destination for this life-saving treatment. As India continues expanding CAR-T access and developing next-generation improvements, the country is positioned to lead global efforts in making advanced cancer immunotherapy available to all who need it.

The oncology revolution is here—and it’s happening in India.