Still seems new and with relatively low sample sizes (although hard to be sure since it sounds like it's been more widely used than the work described in this paper), but potentially very exciting, especially since it seems to be pretty broadly applicable to a large number of auto-immune disorders.
'It's all gone': CAR-T therapy forces autoimmune diseases into remission
11–20 of 34 posts
Re: 'It's all gone': CAR-T therapy forces autoimmune diseases into remission
#12Re: 'It's all gone': CAR-T therapy forces autoimmune diseases into remission
#13What about leukemias?
A good friend of mine was cured (knock on wood) of leukemia by CAR-T. She was one of the first people to get it during a clinical trial. She'd been through all the regular chemo, bone marrow transplant, etc as well as 3 other (failed) experimental treatments and was nearly beyond hope. It seems pretty certain that CAR-T saved her life. I went hiking with her not too long ago. Pretty amazing.
Re: 'It's all gone': CAR-T therapy forces autoimmune diseases into remission
#14> CAR-T therapy can have severe side effects, and recipients must first undergo intensive chemotherapy that kills off many of their existing immune cells. Damn, that really seems like a last resort.
I have MS. I'm in my mid-40s and have few day-to-day symptoms. I'm fairly lucky so far.
But that could all change tomorrow. Some years ago, I woke up and couldn't see out of my right eye. It got better, but it took months to heal (and I was kind of lucky with that, too). I still have reduced grip strength from a 'flare' a few years back. What next? All it takes is one flare to make my life more difficult forever.
The current medicines tend to reduce disease activity - which means most folks have less disability and more mobility than in previous decades - and all have some side effects, which vary in intensity. At least there are pills now: The older drugs were injected at home and tended to make folks feel even worse than modern drugs.
Last resort? Not really. It might be worth the risk of chemo just to not have to have this sort of uncertainty every day. I know chemo brings its own risks, but at least there is a more clear path on what might happen.
Re: 'It's all gone': CAR-T therapy forces autoimmune diseases into remission
#15> CAR-T therapy can have severe side effects, and recipients must first undergo intensive chemotherapy that kills off many of their existing immune cells. Damn, that really seems like a last resort.
> that really seems like a last resort Have we had a compelling reason to research drugs whose primary purpose is to kill bone marrow in healthy patients before?
Sure we have, melphalan is being used to treat multiple myeloma for decades now.
Kill all the cancer in your bone marrow and transplant new stem cells to regrow it.
Re: 'It's all gone': CAR-T therapy forces autoimmune diseases into remission
#16> CAR-T therapy can have severe side effects, and recipients must first undergo intensive chemotherapy that kills off many of their existing immune cells. Damn, that really seems like a last resort.
> that really seems like a last resort Have we had a compelling reason to research drugs whose primary purpose is to kill bone marrow in healthy patients before?
Several forms of immune system cancer treatment involve nuking the immune system and getting a bone marrow transplant from a healthy donor.
Leukemia for sure, and I think also a few kinds (or at least stages) of lymphoma.
Re: 'It's all gone': CAR-T therapy forces autoimmune diseases into remission
#17> CAR-T therapy can have severe side effects, and recipients must first undergo intensive chemotherapy that kills off many of their existing immune cells. Damn, that really seems like a last resort.
After having seen what various auto immune diseases can do to people, I would easily take a 5-10% risk of death for a cure.
Re: 'It's all gone': CAR-T therapy forces autoimmune diseases into remission
#18What about leukemias?
A good friend of mine was cured (knock on wood) of leukemia by CAR-T. She was one of the first people to get it during a clinical trial. She'd been through all the regular chemo, bone marrow transplant, etc as well as 3 other (failed) experimental treatments and was nearly beyond hope. It seems pretty certain that CAR-T saved her life. I went hiking with her not too long ago. Pretty amazing.
That's awesome to hear! Love hearing good news like this
Re: 'It's all gone': CAR-T therapy forces autoimmune diseases into remission
#19> CAR-T therapy can have severe side effects, and recipients must first undergo intensive chemotherapy that kills off many of their existing immune cells. Damn, that really seems like a last resort.
chemo is well known for the treatment being worse than the disease...in the short term. when it works, the long term effect is well worth it.
This depends on the chemo dose. Curative chemo doses are worse in the short term. But palliative chemo usually improves quality of life.
Re: 'It's all gone': CAR-T therapy forces autoimmune diseases into remission
#20> CAR-T therapy can have severe side effects, and recipients must first undergo intensive chemotherapy that kills off many of their existing immune cells. Damn, that really seems like a last resort.
I understand that is similar to any chemotherapy no? But your body will rebuild it after ˜30days.
Chemotherapy typically isn't churn-and-burn to that extent, no.
I got CAR T-cell therapy after one complete line and a partial line of chemotherapy for Primary Mediastinal B-Cell Lymphoma, a form of Diffuse Large B-Cell Lymphoma. My first line was DA-EPOCH-R, where DA means Dose-Adjusted and EPOCH-R is one letter for each of the specific drugs involved. The drugs are given in multiple 24-hour doses over five days with multiple weeks in between, in a 21- to 28-day cycle. This lasts months, for a total of eight cycles or so.
I got an abbreviated second line of R-GemOx, which is three drugs, one of which is oxaliplatin which is, as a platin, substantially more toxic than other chemotherapy agents. That's given over the course of two days for a few hours each day, typically in an infusion center in the hospital as opposed to a hospital bed, with two weeks in between doses.
The point is, there's plenty of time and blood tests between rounds of normal chemotherapy. The point isn't to keep you low, it's to bring you low and let you recover for a bit before cycling you through again. They even give colony-stimulating factors, such as Neupogen and Neulasta, to stimulate cell production between rounds, and they give Claritin to prevent the bone pain you might otherwise get from those drugs causing your bone marrow to swell.
(The oncologist at MD Anderson was slightly horrified I was even getting R-GemOx and moved me immediately to either CAR T-cell or stem cell transplant; due to an unpromising PET/CT scan I got CAR T-cell therapy. So, no, it isn't last-ditch, but it wasn't first-line when I was sick, at least at the hospital I initially went to. However, the thinking on that might be changing. [1] [2])
Anyway, prior to the CAR T-cell infusion, I got three days of back-to-back-to-back high-dose chemotherapy specifically to destroy my immune system. It was the same drugs, not different drugs in a regimen, and by day three I was definitely feeling it worse than I ever did with DA-EPOCH-R but not as bad as my first round with oxaliplatin, which is the devil and has come to do the devil's work. The damn drug makes cold things feel like they've grown spikes, for crying out loud. How is that even possible?
[1] https://ashpublications.org/blood/article/140/Supplement%201...
[2] https://www.mdanderson.org/newsroom/car-t-cell-therapy-effec...