The Barbara Ann Karmanos Cancer Institute in Detroit is the first center in Michigan approved to treat adult patients with diffuse large B-cell non-Hodgkin lymphoma, or DLBCL, with the commercially approved chimeric antigen receptor (CAR) T-cell therapy. Karmanos Cancer Institute took part in the CAR-T clinical trials that led to the U.S. Food and Drug Administration approval of the therapy for this type of lymphoma in 2017.
Patients with DLBCL who have not responded to at least two other types of treatment, or who have relapsed following other treatment, may be eligible for CAR-T therapy. Diffuse large B-cell lymphoma is the most common form of non-Hodgkin lymphoma, or NHL, representing approximately 30 percent of newly diagnosed cases of NHL in the United States. DLBCL is aggressive and occurs primarily in adults.
"In the field of oncology, this is a big breakthrough," said Abhinav Deol, M.D., medical oncologist for the Karmanos Cancer Institute and associate professor of Oncology for the Wayne State University School of Medicine. "Karmanos is very pleased to have been part of the treatment study, which earned FDA approval after decades of research, now making this treatment available to more patients with this challenging disease. This is good news for those with diffuse large B-cell lymphoma, since the success rate with other types of treatment has been minimal."
Joseph Uberti, M.D., Ph.D., Karmanos division chief of Hematology and co-director of Bone Marrow Transplant, and professor of Oncology for the WSU School of Medicine, said that Karmanos's transplant experience and expertise was a critical factor in being designated a CAR-T clinical trial site and Michigan's first approved CAR-T site for DLBCL.
"Karmanos is one of the largest and best centers in the country for stem cell transplantation with some of the best survival outcomes for related and unrelated stem cell transplantation," Dr. Uberti said. "With a highly-trained and experienced medical team in place, we are well prepared and honored to care for patients undergoing CAR-T therapy."
CAR-T therapy is a type of immunotherapy made from a patient's own white blood cells, which are genetically modified to recognize and attack the patient's cancer cells. After the Karmanos specialists determine a patient is eligible for treatment, the following steps are taken:
T-cells are removed from the patient's body using an apheresis process by Karmanos' transplant team.
Once the T-cells are collected, they're shipped to an outside, quality-controlled manufacturing facility where they're modified with the chimeric antigen receptor. This process takes approximately two to three weeks. During that time, the patient undergoes a short chemotherapy regimen to prepare the patient's body for the CAR-T cells. The armed CAR-T cells are then shipped back to Karmanos.
Karmanos' Stem Cell Transplant Team works very closely with the patient and manufacturing facility arming the T-cells to make sure that the timing of the process and the return of CAR-T cells is accurately planned.
Once the armed CAR-T cells are back at Karmanos, they are infused into the patient. They multiply to become an army of CAR-T cells that recognize and destroy the cancer cells.
Dr. Deol said these armed cells are a living treatment that will remain in the body to help prevent the cancer from returning.
The patient should expect to be hospitalized for approximately two weeks. Depending on the severity of the side effects, the hospital stay could be longer and even involve some time in the Intensive Care Unit.
The goal of CAR-T therapy is to put the patient's disease in long-term remission. Although CAR-T is a very promising treatment, it's not for everyone. The one-time treatment is expensive and not all health insurances cover this therapy.
CAR-T is a one-time treatment to put the patient's disease in remission. As with any new treatment, long-term outcomes data is not available. However, for DLBCL patients who have failed other lines of treatment and, in some cases, failed stem cell transplant, this treatment could be a lifeline.
"Following CAR-T therapy, we're seeing initial positive response rates in the range of 80 percent and long-term response rates, approximately one year or longer, up to 45 percent," Dr. Deol said. "As more data becomes available, we hope to see an even longer time in remission."
Dr. Deol believes this promising therapy could become a new treatment option for other cancers in the future.
For more information on CAR-T therapy or other cancer services, call 1-800-KARMANOS (1-800-527-6266) or visit www.karmanos.org/CART-Therapy.