Introducing Kymriah Therapy, A Game Changing Advance in Treating Blood Cancers
Roger Williams Cancer Center is the only cancer program in Rhode Island to offer an exciting therapy for the treatment of blood cancers.
Kymriah is an innovative CAR-T cell therapy for certain types of blood cancers, in which the patient’s own T cells are removed from the patient’s body, reengineered to destroy cancer cells and then returned to the patient’s body. Immunotherapy has changed the landscape of cancer therapy and CAR-T-cell therapy is the culmination of about 30 years of that research.
For eligible patients, the response rates from Kymriah therapy show 90% of patients may go into a deep remission and potentially 60% of patients can be cured. Given that those patients were effectively out of standard options before this therapy became available, those response rates are staggering.
For Referring Physicians
Patient Information Video
Which patients are candidates for CAR T-cell therapy?
At RWMC we can treat 3 main groups of patients at this time with a CAR T-cell therapy called Kymriah:
- Young adults up to age 25 with B-cell acute lymphoblastic leukemia who are refractory or in 2nd or later relapse
- Adults with diffuse large B-cell lymphoma who have failed 2 lines of upfront therapy
- Adults with follicular lymphoma who have failed 2 lines of upfront therapy
How is CAR T-cell therapy delivered to a patient?
The process starts by identifying an appropriate patient for the therapy who then comes to the Roger Williams Cancer Center to undergo a blood collection process called apheresis, where we collect the patient’s own T cells.
After collection, those cells are shipped to a manufacturing facility where the cells are genetically altered to create the CAR T-cell product, Kymriah.
That usually takes 3-4 weeks on average, and during that time we will typically give the patient bridging chemotherapy to keep their disease at bay before the CAR T-cell product is ready to be infused into the patient.
When the modified cells are complete, we receive the product back from the manufacturing facility cryopreserved (or frozen) so that we can store it until the patient is ready for infusion.
In the 3 to 5 days before infusion, the patient will have conditioning chemotherapy to prepare the patient’s body for the t-cells.
On the day of infusion, we bring the frozen Kymriah product to the patient and thaw it at their bedside immediately prior to infusion.
Many patients will receive the infusion as an outpatient in the cancer center and will be able to go home after the infusion. Some will be admitted to the Blood and Marrow Transplant and Cellular Therapy department to have the infusion and monitoring done in the hospital.
We follow the patient closely over the next month evaluating their response and treating them for any side effects they may develop.
How is this coordinated between a referring physician and Roger Williams?
The process is a collaboration between the referring physician and the Blood and Marrow Transplant and Cellular Therapy team at Roger Williams.
Our coordinators work closely with the referring physician to gather health information that the patient has consented to share and to update each other on the patient’s status throughout the treatment process.
The only two parts of the process where the patient needs to be at Roger Williams or in the immediate vicinity, are the 1 to 2 days required to collect the T-cells, and the 4 to 5 weeks during and after infusion.
The remainder of the time we can work with the patient’s local or referring physician to provide treatment and monitoring as well as follow-up after they receive their CAR T-cells.
What are the risks and side effects of CAR T-cell therapy?
The two main risks of CAR T-cells are conditions called Cytokine Release Syndrome, or CRS, and neurotoxicity.
The timing of developing these two side effects can be different. CRS generally develops within 1-7 days after infusion. Neurotoxicity is usually seen later, within a week to a month after receiving the infusion
We screen patients to assess the potential risks of developing these side effects and give preventative or treatment medications. Fortunately, in virtually all cases, CRS and neurotoxicity are reversible.
These side effects occur early and are reversible, while those seen in chemotherapy and transplant can be prolonged. This is one reason we believe there is an advantage to CAR T-cell therapy.
Do CAR T-cells always work?
Like all cancer therapies, CAR T-cells do not work in every patient.
There are 2 main reasons why CAR T-cells do not work. In about 10% of patients the CAR T-cells do not expand or engraft in the patient after they are infused. In another 30% of patients, they engraft and the patient responds, but then some months later, the patient’s disease comes back, usually because it has learned and adapted and no longer expresses the protein that the CAR-T cells were made to target.
Why come to Roger Williams to receive this therapy?
Roger Williams is the only cancer center in the state of Rhode Island certified to provide this therapy. We offer a convenient alternative to travelling out of state and can provide the same level of state-of-the-art care found in facilities in other major metropolitan areas without the stress and expense of being away from home.
We also take referrals from areas around Rhode Island for people who may find it more convenient to travel to Providence for their care.
Additionally, we have the only Blood and Marrow Transplant Center in RI with physicians who are used to caring for very sick cellular therapy patients.
To learn more, email us at BMTinfo@Chartercare.org