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CAR-T Cell Therapy and Reflections on the DNA Day Essay Contest

For the 2026 DNA Day essay writing contest, I chose to write about CAR-T cell therapy, an innovative form of cancer therapy that involves modifying a patient's own cells to recognize cancer. Here I have published the essay along with some reflections and advice for future contestants.

BEGINNER FRIENDLYCOMMENTARY

Sohum Bhardwaj

4/26/20266 min read

Intro

Every year, the American Society for Human Genetics runs an essay competition to celebrate DNA Day. The top three finishers share a two-thousand-dollar prize pool, and their teachers can receive grants for their classrooms.

The competition can be very fun as well, so long as you pick a topic you are genuinely interested in. The prompts are always interesting and relevant. Last year focused on the impact of artificial intelligence in healthcare (something I explore in my blog post on Claude's biotech offerings), and this year the topic focused on genetic therapies.

As someone who is super interested in cancer (not the constellation), I gravitated towards CAR-T cell therapy, an innovative form of cancer treatment involving modifying immune cells to recognize malignant cells. While I didn't win any prizes, my perspective on healthcare was genuinely changed by the research I did. I learned about the realities of financial toxicity and providing specialized treatments.

Now that it has been a few weeks since I submitted, I also have some advice for the future contestants reading this post, so you don't make the same mistakes I did.

This blog post

01 Intro

02 The Essay

03 Works Cited

03 Improvements

My Essay

While standard chemoimmunotherapy successfully cures over 60% of patients with diffuse large B-cell lymphoma (DLBCL), the remaining 40% face an arduous battle, a battle that was fundamentally changed by the FDA approval of axicabtagene ciloleucel, a CAR-T cell therapy [1, 11]. This type of somatic gene therapy has produced durable remissions in patients with several species of hematological cancers that were either refractory to standard treatment or had an early relapse [2]. These cancers, which were once practically “untreatable,” are now approachable conditions [12]. Along with this potential, however, comes new medical and systemic challenges, and as a society we are forced to reconcile astounding medical breakthroughs with the nuanced reality of accessibility to next-generation treatments.

The process of genetically engineering CAR-T cells begins with leukapheresis which is a procedure where the T-cells are isolated from a patient [4]. Then, these cells are taken to a lab where a viral vector, containing DNA coding for a chimeric antigen receptor (CAR), integrates these genes into the T-cell genome [11]. The CAR receptors are made up of a combination of domains, engineered to bind directly to target antigens and induce a rapid immune response [12]. Afterwards, the cells proliferate and then are reinfused into the patient, where they will multiply by up to 1000 times their original number [2]. Chemotherapy is used to suppress the cancer while the T-cells are prepared, and ensure the body doesn’t reject the modified T-cells [4].

One of the most notable results from CAR-T cells is the ability to confer resistance through the formation of memory T-cells which remain in the body for years after infusion. Specific domains, such as the 4-1BB signaling domain have been found to increase this effect, allowing the CAR-T cells to persist more reliably [13]. The advantages of CAR-T cell therapy are reflected in its treatment outcomes, leading to its usage as a 2nd line therapy for DLBCL after multiple successful clinical trials [8, 11].

However, the immense promise of CAR-T cell therapy is contrasted with acute side effects. One clinical trial found CAR-T cells lead to grade 3, or life-threatening, side effects in 91% of patients [8]. Cytokine release syndrome and neurological toxicity through ICANS are two of the most common side effects, both of which are related with immune overstimulation from rapidly proliferating CAR-T cells [2]. Future research is focused on limiting these side effects which represent a key limitation of the therapy’s accessibility.

Chiefly, the severity of these side effects requires expertise from multiple specialists, and, as a result, the majority of CAR-T cell therapy is administered in academic centers [6] in comparison to community centers, of which only 44% offer the therapy [7]. Additionally, patients must live within close proximity of the treatment center for weeks while their symptoms are closely monitored [4]. This is challenging, considering the average distance to a treatment center can be up to 104.4 miles away in poor-access states [3]. For many, the choice to lose unnecessary time during what may be the final year of their life is a sacrifice they shouldn’t have to make.

The majority of CAR-T cell therapy recipients are insured [2], but coverage sometimes fails to shield patients from “financial toxicity.” Surveys of patients who applied for financial assistance due to cancer have found that non-medical costs, such as rent, are cited above medical ones. In fact, younger and lower-income populations were found especially to be vulnerable [10]. Currently, some therapies can cost as much as $168,000-$336,000 per quality-adjusted life year (QALY) gained, whereas the standard acceptable range is $100,000-$150,000 [6]. Consequently, the price of CAR-T therapy is a notable barrier, especially in community clinics where it is one of the top cited reasons for patient refusal [10]. However, future research directions include off-the-shelf allogeneic CAR-T cells that could potentially reduce costs, thereby improving access to the life-saving therapy [5].

CAR-T therapy offers an additional 1.52 QALYs compared to traditional standard treatments [9] and has the potential to induce long-term remission. For an insured patient able to tolerate the toxicity, I would support pursuing this option. Although, we must address logistical realities. If it is not within a patient’s financial means to travel long distances for CAR-T cell therapy, the limitation shifts from medical to geographic. Ultimately, the precision of our medicine must be matched by the equity of its delivery, to ensure that the modern marvels of genetic engineering are not a lottery, but a standard accessible to all.


Works Cited

  1. Abrisqueta, P. (2024). New Insights into First-Line Therapy in Diffuse Large B-Cell Lymphoma: Are We Improving Outcomes? Journal of Clinical Medicine, 13(7), 1929. https://doi.org/10.3390/jcm13071929

  2. Brudno, J. N., Maus, M. V., & Hinrichs, C. S. (2024). CAR T Cells and T-Cell Therapies for Cancer. JAMA, 332(22). https://doi.org/10.1001/jama.2024.19462

  3. Chung, A. P., Shafrin, J. T., Vadgama, S., Hurley, K., Perales, M.-A., Alsfeld, L. C., Muthukrishnan, S., Patel, A. R., Shah, G. L., & Maziarz, R. T. (2025). Inequalities in CAR T-cell therapy access for US patients with relapsed/refractory DLBCL: a SEER-Medicare data analysis. Blood Advances, 9(18), 4727–4735. https://doi.org/10.1182/bloodadvances.2024015634

  4. Cleveland Clinic. (2022, January 19). CAR T-cell therapy. Cleveland Clinic. https://my.clevelandclinic.org/health/treatments/17726-car-t-cell-therapy

  5. Diorio, C., Teachey, D. T., & Grupp, S. A. (2024). Allogeneic chimeric antigen receptor cell therapies for cancer: progress made and remaining roadblocks. Nature Reviews Clinical Oncology. https://doi.org/10.1038/s41571-024-00959-y

  6. ‌Gajra, A., Zalenski, A., Sannareddy, A. et al. Barriers to Chimeric Antigen Receptor T-Cell (CAR-T) Therapies in Clinical Practice. Pharm Med 36, 163–171 (2022). https://doi.org/10.1007/s40290-022-00428-w

  7. Levent, A., Moseley, A., Simons, R., & Adabra, S. (2024). Barriers to CAR-T Therapy Adoption: Comparing Access in Academic and Community Settings in the US. Blood, 144, 5107. https://doi.org/10.1182/blood-2024-211499

  8. Locke, F. L., Miklos, D. B., Jacobson, C. A., Perales, M.-A., Kersten, M.-J., Oluwole, O. O., Ghobadi, A., Rapoport, A. P., McGuirk, J., Pagel, J. M., Muñoz, J., Farooq, U., van Meerten, T., Reagan, P. M., Sureda, A., Flinn, I. W., Vandenberghe, P., Song, K. W., Dickinson, M., & Minnema, M. C. (2021). Axicabtagene Ciloleucel as Second-Line Therapy for Large B-Cell Lymphoma. New England Journal of Medicine, 386(7). https://doi.org/10.1056/nejmoa2116133

  9. Loftager, A. S. L., Danø, A., Eklund, O., Vadgama, S., Hedlof Kanje, V., & Munk, E. (2023). Axicabtagene ciloleucel compared to standard of care in Swedish patients with large B-cell lymphoma: a cost-effectiveness analysis of the ZUMA-7 trial. Journal of Medical Economics, 26(1), 1303–1317. https://doi.org/10.1080/13696998.2023.2260689

  10. Ouchveridze, E., Banerjee, R., Desai, A. et al. Financial toxicity in hematological malignancies: a systematic review. Blood Cancer J. 12, 74 (2022). https://doi.org/10.1038/s41408-022-00671-z

  11. Mitra, A., Barua, A., Huang, L., Ganguly, S., Feng, Q., & He, B. (2023). From bench to bedside: the history and progress of CAR T cell therapy. Frontiers in Immunology, 14(1188049). https://doi.org/10.3389/fimmu.2023.1188049

  12. ‌National Cancer Institute. (2025, February 26). CAR T cells: Engineering immune cells to treat cancer. National Cancer Institute; Cancer.gov. https://www.cancer.gov/about-cancer/treatment/research/car-t-cells

  13. Sun, D., Shi, X., Li, S., Wang, X., Yang, X., & Wan, M. (2024). CAR‑T cell therapy: A breakthrough in traditional cancer treatment strategies (Review). Molecular Medicine Reports, 29(3). https://doi.org/10.3892/mmr.2024.13171

Improvements

After reading the winning submissions and reflected on my writing. There are a few ways I would improve this essay if I had another chance. Here are the issues I identified:

More personalization, less facts
I am a very fact-driven person, and throughout the research I read, I found a lot of facts. I felt as if I needed to include each interesting statistic I found. I didn't realize that every sentence of information came at a cost, my unique voice. The winning essays blended in the personal experiences and perspectives of their writers, not just plain information. I crowded my essay with so much information and sources that I didn't have a chance to let my own experience and perspectives shine through.

Too many arguments
I covered the unequal access of specialists, financial toxicity, and problematic side effects of CAR-T cell therapy along with many other details. In retrospect, each topic got at most 4-5 sentences, which wasn't enough to flesh it out. The reader was left unsatisfied since the ideas felt incomplete. I would have just focused on one specific disadvantage rather than three.

Too specific
It was really hard to judge how specific I should be. As a scientific blog writer, I am not at all afraid to dive into the details of specific pathways and proteins, so I was predisposed to dive into technicalities. I was only able to find previous submissions from 2025. Unfortunately, last year's topic was about AI so the participants didn't delve into medical details, so they weren't a good reference to gauge how specific my details about the treatment should be. Now, I realize that specific domains and clinical trials aren't necessary.

This article was written in April, but published in July