Patients with common yet hard-to-treat blood cancer could benefit from treatment that reprogrammes the immune system to fight the disease.
Chimeric antigen receptor (CAR) T-cell therapy involves collecting infection-fighting white blood cells, known as T-cells, from the patients via a drip.
These are modified over five weeks in a lab, causing them to produce a cancer-fighting protein (the CAR) – creating CAR T-cells. They are then put back into the patient via an intravenous infusion, where they seek out and attack cancer cells.
The therapy has previously only been available on the NHS for certain subtypes of blood cancer – but as part of a pivotal UK clinical trial, it is being tested on a wider group with common forms of the disease. It could throw a lifeline to those who, until now, have faced an uncertain prognosis. It might offer those who have up until now faced an uncertain prognosis a lifeline.
Leukemia, lymphoma, myeloma, and nearly 100 other types of blood cancers all affect blood cells. Each year, more than 41,000 new diagnoses are made in total. In the UK, there are about 25,000 people who suffer from these illnesses.
500 children under the age of 15 are diagnosed with blood cancer each year, making it the most prevalent type of pediatric cancer.
Previously, CAR T-cell therapy was made available to adults with diffuse large B-cell and mantle cell lymphomas and children with B-cell acute lymphoblastic leukemia, collectively affecting about 6,000 patients annually.
B-cell non-lymphoma Hodgkin’s and chronic lymphocytic leukemia, which together affect nearly 19,000 people annually, are the two other types that are currently being tested on patients.
The majority of patients with these cancers respond well to chemotherapy and other treatments, but about 25% of them have the refractory disease, which means they don’t improve or relapse within two years.
CAR T-cell therapy is made available to these groups through the University College London Hospitals (UCLH) NHS Foundation Trust trial. Doctors hope it will be adopted more widely if it is successful.
Professor Claire Roddie, a consultant hematologist at UCLH and the trial’s principal investigator, said: “We’ve found CAR T can put patients with certain blood cancers into long-term remission.” To give other groups hope, we want to replicate this to offer hope to more patients.
After just two CAR T-cell infusions, the first chronic lymphocytic leukemia patient in the UK to receive the therapy revealed he is now free of the illness.
When Robin Edwards, 66, of Buxton, Derbyshire, went to his doctor about a swollen neck ten years ago, he was given the diagnosis. Chemotherapy and immune-stimulating medications were given to him, which stopped cancer from spreading.
He was provided with CAR T-cell therapy as part of the trial when, however, his condition started to deteriorate in 2021. Infusions began for him in May of that year. His doctors informed him that the treatment was successful and that he is currently in full remission.
He remarked, “This is fantastic news. I feel like I’m going to see my two grandchildren, who are five and three years old, and see them grow up.”
The UK approved CAR T-cell therapy in 2018, but there are drawbacks. A sizeable portion of patients experiences negative effects, such as cytokine release syndrome, in which the immune system becomes overactive and injures the patient. A few require admission to intensive care.
Other patients’ CAR T-cell infusions did not “take,” and they vanished from the bloodstream.
A different type of genetically altered CAR T-cell is being used in the trial. According to experts, they are overcoming these two difficulties as a result.
‘A large focus of our work has been on minimizing the toxicity associated with CAR T therapy while maximizing the persistence of CAR T-cells in the body,’ said Dr. Martin Pule, who oversees the University College London CAR T-cell program.
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