Cell Therapy Shows Promise for Acute Type of Leukemia
Published: March 20, 2013 38 Comments
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His oncologist, Dr. Brentjens, suggested that before starting the drugs, Mr. Aponte might want to have some of his T-cells removed and stored (chemotherapy would deplete them). That way, if he relapsed, he might be able to enter a study using the cells. Mr. Aponte agreed.
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At first, the chemo worked, but by the summer of 2012, while he was still being treated, tests showed that the disease was back.
“After everything I had gone through, the chemo, losing hair, the sickness, it was absolutely devastating,” Mr. Aponte recalled.
He joined the T-cell study. For a few days, nothing seemed to be happening. Then, his temperature began to rise. He has no memory of what took place during the next week or so, but the journal article — where he is Patient 5 — reports that his fever spiked to 105 degrees. He was in the throes of a “cytokine storm,” meaning that the T-cells, in a furious battle with the cancer, were churning out enormous amounts of hormones called cytokines. Besides fever, the hormonal rush can make a patient’s blood pressure plummet and his heart rate shoot up. Mr. Aponte was taken to intensive care and treated with steroids to quell the reaction.
Eight days later, his leukemia was gone. Even the doctors were shocked, Dr. Brentjens said. They repeated the lab tests just to make sure there was no mistake.
Once he was in remission, Mr. Aponte had a bone-marrow transplant, as did three of the other patients in the study. Another had medical problems that made a transplant impossible, and it was he who relapsed and died. The researchers think he may have relapsed because the steroids he needed to treat the cytokine storm may have wiped out the T-cells before they could do their job.
For the other patients, it is not known whether the transplants were really needed; in theory, the T-cells alone might have produced a long-term remission or even a cure. Patients treated at the University of Pennsylvania were not given transplants, and most have stayed in remission. But the technique used there involves a different viral vector and different genetic programming from the one used at Sloan-Kettering.
In any case, Dr. Brentjens said, the T-cells are still experimental, whereas transplants are the standard of care in acute leukemia because they have been shown to give many patients the best odds of survival. So the transplants were done for ethical reasons. Thestudy is continuing, and as more patients are treated, answers may emerge as to whether the T-cells alone will be enough for some patients.
Mr. Aponte, who had the transplant in December, is still recovering, and trying to gain back some of the 40 pounds he lost while he was ill. But he hopes to return to work soon. NEW YORK TIMES
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