CAR T-Cell Therapy: Patients' Genetically Modified Cells Take Aim At Treating Lymphoma
INDIANAPOLIS, Indiana – Franciscan Health cancer doctors are using a new tool to treat patients whose lymphoma has returned after being in remission following chemotherapy.
This type of treatment is known as Chimeric Antigen Receptor (CAR) T-cell therapy and it offers a highly targeted approach to treat relapsed diffuse large B-cell lymphomas. Of those diagnosed annually with lymphoma, one third of patients relapse and about 20 percent can be effectively treated with high-dose chemotherapy followed by autologous stem cell transplant. Franciscan Health has explored this treatment in clinical trials since 2016.
The therapy is no longer just in research trial phase and is FDA-approved for use with qualified patients at Franciscan Health. There are also open clinical trials available at Franciscan Health for patients who may not be candidates for the approved treatments.
Few, if any, options are available to patients whose transplants or chemotherapy fails – and that's what makes CAR T-cells promising.
"This innovative and one-of-a-kind approach to cancer treatment is a game changer," said Luke Akard, MD, a cancer specialist with the Indiana Blood & Marrow Transplantation Program (IBMT) at Franciscan Health Cancer Center Indianapolis. "Not only does it offer hope for very sick patients who qualify for CAR T-cell therapy, but it also changes the way research approaches overall cancer treatment."
Dr. Akard is the trial's principal investigator and is joined by IBMT colleagues and co-investigators, John Edwards, MD; Anand Tandra, MD; and Michael Dugan, MD. Six patients have participated in the study since it began and all will be monitored for several years.
Here's how CAR T-cells work: First, the patient's T-cells (essential blood components in the protection against illness and disease) are isolated, collected and analyzed. Then they are sent to a special lab in California where they are processed and genetically modified. This is followed by a rigorous, week-long quality check.
The cells are then returned to Franciscan Health and infused back into the patient and begin to seek and eliminate the cancer cells. The modified cells live on in the body and are designed as a long-term defensive shield against cancer.
Patients undergoing this therapy need to be near Franciscan Health Cancer Center Indianapolis for about a month following the infusion and are regularly monitored for any side effects.
IBMT is one of the two programs in Indiana offering full-service transplant care. The center specializes in the treatment of leukemia, lymphoma, multiple myeloma and other blood disorders. The unit’s physicians and clinical staff also conduct extensive research and numerous clinical trials.
"FDA approval of CAR T-cell therapy is major milestone because it marks the first approved gene therapy treatment in the United States," said Dr. Akard. "More trials are being explored for cellular therapy for many other cancer types and this could be the breakthrough we have hoped for."
Franciscan Health Cancer Center Indianapolis continues with the CAR T-cell therapy trial and offers it as a treatment option for qualified patients.
Precision Targeted Therapy
Jeff Owens has a long table in his garage. A couple of hours each day, he rolls dice, figuring the probabilities of winning a tidy sum at the tables in Las Vegas, which he visits each May to participate in a bowling fundraiser.
In 2017, the odds seemed stacked against the Indianapolis resident. After discovering a mysterious bump on his left arm – and with strong encouragement from his wife Judy – he consulted with physicians at Franciscan Health Cancer Center Indianapolis. Tests revealed the large B-cell lymphoma, which had been in remission after an earlier stem cell transplant at IBMT, had reinvaded his body.
"I had a couple of options but mostly they would have been Band-Aid treatments," Owens recalled. "The doctor told me I could have chemotherapy and radiation and that might put me in remission for a time, but it was only a matter of time before the lymphoma came back."
He also was offered another choice: IBMT had just launched the CAR T-cell therapy clinical trial and Owens was a good candidate for it. So he readily enlisted in the study and became one of the first in the nation to do so.
"I believe all healing comes from God and that he puts doctors, nurses and medicine out front to help the process along," said Owens, a west-side Indianapolis resident. "Judy and I discussed it first and we agreed the T-cell trial was the right thing to do."
Harvesting and processing his T-cells was not painful, just a bit uncomfortable. Compared to rigorous chemotherapy and other treatments he had received in the past (including a fight with colorectal cancer in 2008), the process "went like a breeze and I was on my way home."
A few weeks later, he received three days of chemotherapy to enhance the immune effects of the CAR T treatment before the reengineered cells were returned and infused into Owens' body. These specially modified cells immediately took aim at only the cancerous cells and they continue to serve as a shield.
"I've been in remission for nearly two years," said the retired bus driver for Perry Township Schools. "God's grace and this clinical trial saved my life. And I want it to help others, too."
Photo Caption: Jeff Owens (center) credits his survival to the CAR T-cell therapy he received at Franciscan Health Cancer Center Indianapolis. From left, he's surrounded by his care team RN Jeff Morgan, Dr. John Edwards, Dr. Luke Akard, Dr. Anand Tandra and RN Melanie Coleman.
By Joe Stuteville
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