FIGURE 1 Schematic of CAR structure in relation to CD19 expressing tumor cells . CARs are composed of single-chain variable fragment (shown here as FMC63) joined to an intracellular CD3 zeta signaling domain. Tisagenlecleucel is a second-generation CAR construct that incorporates a second additional co-stimulatory endodomain (4-1BB).

FIGURE 2 Diagram of CAR T cell manufacturing and treatment process . The treatment process starts with leukapheresis of the patient’s peripheral blood mononuclear cells, which is then frozen and shipped to the appropriate manufacturing facility for ex-vivo modifications. T cells are activated and expanded using anti-CD3/anti-CD28 coated beads and expression of CAR is transduced using lentiviral vector. Successfully manufactured products are shipped back to the treating facility, where it is given intravenously back to the patient.