When Karla woke up in the middle of night suffering from severe back pain in March of 2019, little did she know that a massive tumor on her spine was the cause. After a trip to the local emergency department in Parker, Ariz. where she lived, she was quickly whisked off in a helicopter to undergo emergency surgery in Phoenix.
The doctors were able to remove most of the tumor, but a lot of nerve damage had already been done. It was then that she found out she had non-hodgkin lymphoma (NHL), a cancer that starts in white blood cells called lymphocytes, which are part of the body's immune system.
“I couldn’t walk after surgery,” Karla said. But, she was determined to walk again and slowly started her journey.
Karla had to undergo chemotherapy for six weeks in a wheelchair to treat the hard to reach cancer in and around her spine. She slowly transitioned to a walker and then a cane, and after 14 weeks, she was up and walking right after several radiation treatments that led to her remission in October 2019.
Cancer relapse
“In September 2020, I knew it was back,” she said. She felt tired and didn’t want to eat anything. Given the cancer returned just one year after completing her chemotherapy and radiation, it was determined that she would need a hematopoietic stem cell transplant to aggressively treat the cancer.
“This is a stubborn type of cancer,” said Veena Fauble, MD, medical director of blood and marrow transplant at HonorHealth. “The purpose for the transplant was to be able to offer a higher dose of chemotherapy to overcome resistance that may have developed and then, replace the patient’s own hematopoietic s stem cells to make brand new bone marrow for the patient.”
The preparation process for a bone marrow transplant is significant. It can take up to a week of high dose chemotherapy to prepare a patient’s body and can result in an inpatient stay of up to 3-4 weeks.
“This is when we thought that cellular therapy may be a better alternative for Karla,” said Dr. Fauble.
CAR-T therapy process
Although cellular therapy, or CAR-T therapy, is not new, HonorHealth Research Institute had begun a special clinical trial for this novel therapy for the indication of relapsed NHL. After determining that Karla was eligible for the trial, doctors quickly got to work on her treatment plan.
The first step of the CAR-T process is collecting the T cells from the patient. That is done as an outpatient. These cells are then engineered and modified to be able to look for a specific CD-19 antigen expressed on cancer cells. Once the cells are expanded and modified, they are sent back to the hospital for infusion.
The patient then undergoes lymphocyte depleting chemotherapy, which is a process that makes room for the modified T cells that are given back to the patient. Those cells are then infused through a catheter, circulate around and look for their target. This activates the immune system. The entire process of the infusion of the CAR-T product takes a minimal amount of time.
“I remember asking the doctors how the cells know to go to my marrow,” said Karla. “They told me that they just know. It was Christmas time when this happened, and I felt like so many young, bright, amazing people were doing so much to save one old lady’s life.”
Karla and her blood counts were monitored for several weeks after the infusion for any side effects or signs of infection. It wasn’t long before the doctors saw a complete resolution of the lymphoma.
“It was pretty awesome,” said Dr. Fauble. “Seeing her first set of scans showing signs of improvement was truly a rewarding experience. We are thrilled to bits when our patients do well.”
Karla continued to travel to the Valley every three weeks following her CAR-T therapy, and soon graduated to every three months.
“My hair is growing back, and I even put color on it recently,” she said. “I remember when I arrived, I was broken and my body was broken, but I have been strong and authentic, and I hope it lasts for a while.”
“We want to continue to offer these treatments that have now been FDA approved, and are building a comprehensive CAR-T program to continue to offer these therapies,” said Dr. Fauble. “It truly takes a team to ensure our patients have positive outcomes like Karla’s story.”