CAR-T cell therapy is a treatment that harnesses the power of a person's immune system to combat cancer cells. In this regenerative immunotherapy, a person's T cells, or white blood cells known as lymphocytes that are involved in the immune system response — are collected and genetically modified to produce chimeric antigen receptors or CARs. They are then infused back into the patient's blood stream, where they target and destroy cancer cells. Mayo Clinic researchers are advancing and improving CAR-T cell therapy to expand its capabilities to treat more conditions. Read more about the latest advances in CAR-T at Mayo Clinic. 

CAR-T cell researchers at Mayo Clinic optimistic about future of treating blood cancers 

While many CAR-T cell therapies use a patient's own cells, Mayo Clinic is also exploring the applications of allogeneic, or "off-the-shelf," CAR-T therapies. These are generated by healthy donors or gene-edited sources that have been genetically altered to reduce the possibility of rejection by the patient's immune system. 

"This can provide a faster turnaround time for manufacturing, expand patient access and allow patients to receive CAR-T cell therapy at the time of need," says Yi Lin, M.D., Ph.D., a hematologist and oncologist at Mayo Clinic Comprehensive Cancer Center. 

CAR-T cell therapy is usually offered as a later-stage therapy for various blood cancers, but recent research has shown it may be useful in some blood cancer cases earlier in a patient's treatment plan.

"CAR-T cell therapy in earlier lines of treatment has reported superior outcomes as compared to using it in later lines of therapy," says Rafael Fonseca, M.D., hematologist at Mayo Clinic Comprehensive Cancer Center. 

Unleashing CAR-T cell therapy to destroy solid tumors in thyroid cancer 

Mayo Clinic researchers are working to apply CAR-T cell therapy to solid tumors in thyroid cancer. CAR-T has shown promising results in blood cancers, and new research is focused on using this treatment on more types of malignancies.

"CAR-T cell therapy is unlike other therapeutics," says Saad Kenderian, M.B., Ch.B., a hematologist and cancer researcher. "Other therapies may slow down cancer. CAR-T cell therapy has shown great promise in stopping B-cell lymphomas and leukemias. Some of my patients have gone into complete remission that has lasted for years after just one treatment." 

Could CAR-T cell therapy improve kidney transplants? 

CAR-T cell therapy could provide a revolutionary approach to organ transplantation for "sensitized patients" who are hard to match and susceptible to rejection, Mayo Clinic researchers discovered. 

Their pioneering research focuses on using CAR-T cells derived from the patient's own immune system to prevent rejection of donated organs. Sensitized patients are those who have high levels of antibodies that cause their immune systems to react negatively to potential donor organs. These patients often face extended waiting periods for a transplant. 
 
Research from this proof-of-concept study is published in Kidney International. 
 
"This research is one of the first steps toward applying CAR-T cells in the field of transplantation to try to make more donor organs available for transplant and reduce the wait for patients who need a new kidney," says Tambi Jarmi, M.D., first author on the study and a transplant nephrologist at Mayo Clinic in Florida. 

Mayo Clinic scientists pioneer immunotherapy technique for autoimmune diseases

Mayo Clinic scientists have developed an immunotherapy strategy that potentially lays the groundwork for treating a spectrum of autoimmune diseases.

The new technique, detailed in a preclinical study published in Nature Biomedical Engineering, involves combining chimeric antigen receptors (CARs) with mesenchymal stromal cells (MSCs), which are found in various tissues in the body and are known for calming down the immune system, controlling inflammation and promoting immune tolerance to prevent the body's own tissues from being attacked. 

"The pioneering approach shows potential in targeting inflammatory disease sites more precisely and improving immunosuppression and healing outcomes," says Dr. Kenderian. "We're planning to study interventions that minimize the need for long-term medications for autoimmune diseases." 

Unleashing viruses aimed at killing cancer 

Mayo Clinic cancer researcher Richard Vile, Ph.D., is leading research into genetically engineered viruses aimed at unleashing a two-pronged attack on cancer. One part of this technology, known as an oncolytic virus, is designed to infect, break open and destroy cancer cells while sparing healthy tissue. Dr. Vile's preclinical studies have shown that oncolytic viruses replicated in cancer cells and cascaded to kill other diseased cells. That, in turn, triggered an immune response in which the patient's own T cells, stimulated by the virus, recognized and targeted metastasized tumors for a second wave of cancer destruction.

"Oncolytic viruses are a way to alert the immune system and mobilize it to kill cells infected with cancer," says Dr. Vile. "There's the direct killing of cancer cells with the virus, and then there's the major effect of immune activation. The immune system is incredibly well evolved to recognize infection, clear infection and kill all the cells around it that could be harboring infection." 

Dr. Vile's team is combining oncolytic viruses with CAR-T cell therapy to target solid tumors from liver cancer. This experimental approach of loading CAR-T cells with oncolytic virus is a new way to expand CAR-T cell therapy beyond treatment for blood cancers into treatment for solid tumors. 

Preparing to biomanufacture a new CAR-T cell therapy for B-cell cancers 

Mayo Clinic research has developed a new type of CAR-T cell therapy aimed at killing B-cell blood cancers that have returned and are no longer responding to treatment. This pioneering technology, designed and developed in the lab of Hong Qin, M.D., Ph.D., killed B-cell tumors grown in the laboratory and tumors implanted in mouse models. The preclinical findings are published in Cancer Immunology, Immunotherapy. 

"This study shows our experimental CAR-T cell therapy targets several blood cancers, specifically chronic lymphocytic leukemia," says Dr. Qin. "Currently there are six different CAR-T cell therapies approved for treatment of relapsed blood cancers. While the results are impressive, not everyone responds to this treatment. Our goal is to provide novel cell therapies shaped to each patient's individual need."

Dr Qin's team developed a cell therapy to target a protein known as B-cell activating factor receptor (BAFF-R) found in patients with B-cell cancers, particularly those with chronic lymphocytic leukemia. The BAFF-R protein is linked to tumor growth. The cell therapy under investigation allows the immune system to quash cancer and target tumors that have returned or have resisted available CAR-T cell therapies. 

Using a molecular scissors to improve CAR-T cell therapy 

Mayo Clinic researchers who mined the molecular foundations of cancer have uncovered a new reason CAR-T cell therapy fails in some patients. This discovery has fueled new strategies that incorporate antibodies and gene editing to improve the outcome of this breakthrough treatment.  

"This is a very exciting discovery that offers new hope of overcoming challenges of CAR-T cell therapy that many cancer patients experience," says Dr. Kenderian, a hematologist and senior author on this research, published in Nature Communications. 

"We describe for the first time a mechanism causing the resistance and failure of CAR-T cells, which lies within a protein routinely made by the engineered cells. This research puts us on a new path for improving the longevity of CAR-T cell therapy." 

The post 7 advances in CAR-T cell therapy at Mayo Clinic appeared first on Mayo Clinic News Network.

ROCHESTER, Minn. — Survival outcomes using chimeric antigen receptor-T cell therapy (CAR-T cell therapy) continue to be impressive for patients with some blood cancers.

“Five years ago, the survival rate for people with blood cancers was 10% to 15%. Nowadays, we are seeing a survival rate of 40%. The job is not done yet," says Mohamed Kharfan Dabaja, M.D., a hematologist and director of blood marrow and transplantation and cellular therapies at Mayo Clinic Comprehensive Cancer Center. "We need to continue to bring new therapies, and to understand not only why it is not working on a certain patient but why it is in others and that will bring new knowledge about how to improve treating blood cancers."

What is CAR-T cell therapy?

Immunotherapy uses the body’s immune system to fight cancer. CAR-T cell therapy is a form of immunotherapy in which healthcare professionals remove a person’s T cells — white blood cells known as lymphocytes that are involved in the immune system response — and genetically modify them to produce chimeric antigen receptors (CARs). These CAR-T cells are then infused back into the patient's bloodstream, where they target and destroy cancer cells. CAR-T cell therapy is used primarily for blood cancers like multiple myeloma, leukemias and lymphomas.

Manufacturing CAR-T cells

Because of the encouraging results from CAR-T cells, Mayo Clinic researchers are persistent in searching for ways to expand their use. Saad Kenderian, M.B. Ch.B., a hematologist and oncologist at Mayo Clinic Comprehensive Cancer Center, and a team of Mayo Clinic researchers are investigating ways to make CAR-T cell therapy more accessible to patients through on-site biomanufacturing at Mayo Clinic's campuses in Rochester, Minnesota, and Jacksonville, Florida.

"Being able to manufacture CAR-T cells in our lab will open the door for patients getting treatment faster, tailoring the treatment to their need, and potentially provide another option to patients who didn't respond to the conventional, commercial-approved CAR-T cell therapy," states Dr. Kenderian.

"Another strategy currently being tested in clinical trials uses allogeneic CAR-Ts, essentially CAR-T made from another source. This can provide a faster turnaround time for manufacturing, expand patient access and allow patients to receive CAR-T cell therapy at the time of need," says Yi Lin, M.D., hematologist and oncologist at Mayo Clinic Comprehensive Cancer Center.

Allogeneic "off-the-shelf" CAR-T therapies are generated by healthy donors or gene-edited sources that have been genetically altered to reduce the possibility of rejection by the patient's immune system. This approach is not yet approved by the Food and Drug Administration (FDA).

Using CAR-T cell therapy earlier during treatment for some blood cancers

While CAR-T cell therapy is initially offered as a therapy later during treatment for various blood cancers, recent research has shown it may be useful in some blood cancer cases earlier in a patient's treatment plan. "CAR-T cell therapy in earlier lines of treatment has reported superior outcomes as compared to using it in later lines of therapy," says Rafael Fonseca, M.D., hematologist at Mayo Clinic Comprehensive Cancer Center.

Next-generation CAR-T cell therapy trials are expanding into new tumor types like solid cancers and exploring new techniques such as using donor T-cells or immune cells other than T-cells, such as natural killer cells (NK cells), which are white blood cells that can destroy tumor cells. 

Limiting the incidence and severity of side effects of CAR-T cell therapy

As with most cancer treatments, the side effects of CAR-T cell therapy can be unpleasant. They may include:

Cytokine release syndrome (CRS): This occurs when modified T-cells are introduced into a patient's bloodstream. As the T-cells start targeting cancer cells, they release a large number of cytokines — proteins that can cause the immune system to overreact. This can include a fever, low blood pressure, muscle pains and flu-like symptoms.

Neurotoxicity: This is a potentially dangerous condition in which the immune response to the treatment affects the central nervous system. While the exact cause of neurotoxicity is not well understood, some studies suggest that it is partly related to the severity of CRS. Symptoms can include confusion, seizures and difficulty speaking or walking.

Blood disorders: CAR-T cell therapy can result in blood changes that can lead to anemia, thrombocytopenia (low platelet count) and other blood disorders. These effects are generally short-lived and resolve themselves over time, but they can be more severe in some patients.

Scientists are researching how using corticosteroids, and timing for when they are administered during treatment, could help lessen the side effects or make them more tolerable. "The future looks bright, and we will eventually get to that concept of not just treating cancer but treating cancer in a patient with the least amount of side effects and with maximum efficacy — that's really where the gold is going to be," says Dr. Kharfan Dabaja.

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About Mayo Clinic Comprehensive Cancer Center
Designated as a comprehensive cancer center by the National Cancer Institute, Mayo Clinic Comprehensive Cancer Center is defining new boundaries in possibility, focusing on patient-centered care, developing novel treatments, training future generations of cancer experts and bringing cancer research to communities. At Mayo Clinic Comprehensive Cancer Center, a culture of innovation and collaboration is driving research breakthroughs that are changing approaches to cancer prevention, screening and treatment and improving the lives of cancer survivors.

About Mayo Clinic
Mayo Clinic is a nonprofit organization committed to innovation in clinical practice, education and research, and providing compassion, expertise and answers to everyone who needs healing. Visit the Mayo Clinic News Network for additional Mayo Clinic news.

Media contact:

• Kelley Luckstein, Mayo Clinic Communications, newsbureau@mayo.edu

The post CAR-T cell researchers at Mayo Clinic optimistic about future of treating blood cancers appeared first on Mayo Clinic News Network.

As a physician at the forefront of new cancer therapies, Yi Lin, M.D., Ph.D., understands the highs and lows that patients experience. Will the latest technologies slow or stop disease? If not, is this the last, best option?

Dr. Lin, a hematologist, sees the need for a new class of drugs that provides different treatment choices for patients with complex conditions, such as cancer. As the new associate medical director for Mayo Clinic's Center for Regenerative Biotherapeutics,  she'll assist in delivering promising new therapies to the practice. Dr. Lin and the center's leadership will focus on accelerating biological therapies — medicines manufactured from human sources, such as cells, blood, tissue, proteins or genes. Biologics have shown potential for more targeted healing, sometimes with fewer side effects, than standard drugs.

Among her many roles at Mayo, Dr. Lin also is the medical director of the Immune Effector Cell Program in Rochester, Minnesota, and enterprise leader of Cancer Regenerative Biotherapeutics with the Mayo Clinic Comprehensive Cancer Center.

"The technology of manipulating a patient's own cells to better enable them to do what they're naturally capable of — fight disease — is very important," says Dr. Lin. "Cellular therapies show potential for more individualized treatment for patients. The first generation of such therapies are now standard of care, with a lot more research to fully realize their potential."

"Mayo Clinic is poised to be an international leader in manufacturing new regenerative biotherapeutics. I am honored and excited to work with my colleagues to bring regenerative therapies to conditions beyond cancer to new areas of the practice." ~Yi Lin, M.D., Ph.D.

Dr. Lin launched the first chimeric antigen therapy (CAR-T) cell therapy clinical trial at Mayo Clinic and has led efforts to integrate it into the practice. CAR-T cell therapy is a regenerative immunotherapy that harnesses the body's defense system by genetically modifying cells, equipping them to go on search-and-destroy missions to kill cancer.

The Food and Drug Administration has approved six CAR-T products for blood cancers. Dr. Lin and leaders in the Center for Regenerative Biotherapeutics see the need for new CAR-T therapy options that also will kill solid tumors. The long-term goal is to apply regenerative technologies to cancer and many other conditions. Priorities include:

• Malignant cell therapies — such as CAR-T cell therapy.
• Nonmalignant cell therapies for conditions such as diabetes.
• Gene and viral therapies  for treating conditions such as osteogenesis imperfecta, an inherited brittle bone disease.
• Exosomes and extracellular vesicles — exosomes act like a cargo service that delivers healing messages into damaged cells. Preclinical studies of exosomes have shown potential to regenerate skin and skeletal muscle.
• Tissue engineering & bioprinting. Examples would include printing nasal and larynx implants for restoring health after cancer.

Read the rest of the article on the Center for Regenerative Biotherapeutics blog.

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Other Mayo Clinic medical research websites:

• Research at Mayo Clinic
• Discovery’s Edge
• Advancing the Science
• Mayo Clinic Laboratories
• Forefront
• Center for Individualized Medicine
• Center for the Science of Health Care Delivery
• Mayo Clinic Cancer Center

The post Science Saturday: Expanding regenerative biotherapeutics to new practice areas appeared first on Mayo Clinic News Network.

Mayo Clinic marks its 10,000 blood and marrow transplant in Minnesota

ROCHESTER, Minn. — In the six decades since blood and marrow transplantation was used to treat patients with blood cancers, this once experimental treatment has become a vital cancer-fighting tool. Mayo Clinic in Rochester, Minnesota, is celebrating the 10,000^th blood and marrow transplant used in the treatment of blood cancers and related disorders.

Mayo Clinic performed its first bone marrow transplant in 1963. Today, hundreds of people receive blood and marrow transplants every year at Mayo Clinic in Arizona, Florida and Minnesota.

This latest milestone is a time for reflection on the impact this treatment has had on the lives of many patients and families. But it is also important to continuously strive to improve the therapy to make it safer and more effective by incorporating new research and other promising developments, says William Hogan, M.B., B.Ch., director of Mayo Clinic’s Blood and Marrow Transplant Program in Minnesota.

"It was only with the major contributions of many patients, nurses, researchers and providers over many decades that blood and marrow transplants have been developed into an effective treatment for so many," Dr. Hogan says. "It is awe-inspiring to reflect on the impact of this therapy on so many patients over the past 60 years. We look forward to an era of rapid innovation and providing even better patient-centric therapies for a range of devastating diseases."

Here are five of the most promising advances in blood and marrow transplantation, including new ways of treating blood cancers:

1. Use of mismatched donors:

Blood and marrow transplantation  infuses healthy blood-forming stem cells into the body to replace bone marrow that has an underlying malignancy or defect that makes it unable to function normally. It is one of the first forms of regenerative medicine. The stem cells can come from a person’s own cells – known as an autologous transplant, and this is an effective strategy for many blood cancers, such as lymphoma and multiple myeloma. However, if the bone marrow is already compromised by certain cancers or is failing for other reasons, then a transplant from a donor called an allogeneic transplant may be more appropriate. Fully matched donors, such as a matched sibling, were the safest option initially. But thanks to recent advances, less well-matched donors, such as half-matched family members, are often considered.

2. Reduced-intensity conditioning:

Many cancers affect older people, but blood and marrow transplants were previously limited to young people. Older people not healthy enough for a blood or marrow transplant now have more options thanks to an approach that provides lower doses of chemotherapy and radiation before a transplant.

3. CAR-T cell therapy:

Chimeric antigen receptor-T cell (CAR-T cell) therapy is a newer form of cell therapy used to fight cancer. The procedure involves taking the T cells from a person and reengineering them to recognize and destroy cancer cells. This immunotherapy treatment has been especially helpful in treating blood disorders, such as leukemia, lymphoma and multiple myeloma, and is rapidly expanding to other cancers.

4. Biomarkers to recognize serious complications early:

Researchers have discovered metabolic markers that can predict an individual's risk for developing severe graft-versus-host disease — a serious complication of blood and marrow transplants in which the donor’s immune cells start to attack the recipient’s healthy tissues. This allows prompt personalized treatment.

5. Using bone marrow transplants to treat other conditions:

Mayo Clinic researchers are examining whether stem cell transplants can treat other conditions, such as multiple sclerosis.

While these advances are heartening, the need for more bone marrow donors — especially from people from diverse racial and ethnic backgrounds — remains strong. The key is encouraging more people to register to become a donor at Bethematch.org.

JOURNALISTS: Several Mayo Clinic transplant experts are available for interviews:

• William Hogan, M.B., B.Ch., hematologist, oncologist and director of Mayo Clinic Blood and Bone Marrow Transplant Program in Minnesota.
• Mohamed Kharfan Dabaja, M.D., hematologist, oncologist and director of Mayo Clinic’s Blood and Marrow Transplantation and Cellular Therapy Program in Florida.
• Yi Lin, M.D., Ph.D., hematologist, oncologist and medical director of Mayo Clinic’s Immune Effector Cell Program in Minnesota.

In addition, B-Roll of a celebration event including Mayo's very first bone marrow transplant recipient, Nancy Mclain and Robert Kyle, M.D., who performed the procedure is available in downloads below. Journalists who would like to access the video can register with the News Network here.

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About Mayo Clinic    
Mayo Clinic is a nonprofit organization committed to innovation in clinical practice, education and research, and providing compassion, expertise and answers to everyone who needs healing. Visit the Mayo Clinic News Network for additional Mayo Clinic news. 

Media contact:

• Heather Carlson Kehren, Mayo Clinic Communications, newsbureau@mayo.edu

The post Expert alert: Five key medical advances related to bone marrow transplantation appeared first on Mayo Clinic News Network.

Multiple myeloma is a cancer that forms in a type of white blood cell called a plasma cell. 

Healthy plasma cells help the body fight infections by making antibodies that recognize and attack germs. In multiple myeloma, cancerous plasma cells accumulate in the bone marrow and crowd out healthy blood cells. Rather than produce helpful antibodies, the cancer cells produce abnormal proteins that can cause complications.

Immunotherapy, which uses the body's immune system to fight cancer, is now a standard treatment option for multiple myeloma. Immunotherapy works by interfering with cancer cells' ability to produce proteins that help them hide from the immune system.

"Immunotherapy is really one of the major backbones of our current treatment for multiple myeloma," explains Dr. Yi Lin, a hematologist at Mayo Clinic. "We have some new agents that really help extend the amount of time that patients are able to live with multiple myeloma."

While there is no cure, treatment options for multiple myeloma are advancing quickly and new immunotherapies, including chimeric antigen receptor (CAR)-T cell therapy, are improving outcomes for patients.

"We always want to strive towards the treatment that we think can offer the longest period of remission," says Dr. Lin. "But balancing that with side effects because we want to keep patients not only living as long as they can with multiple myeloma, but hopefully also with good quality of life."

March is Myeloma Awareness Month. On this Mayo Clinic Q&A podcast, Dr. Lin discusses the use of immunotherapies and other novel approaches to treating multiple myeloma.

Watch: Dr. Lin discuss immunotherapy for multiple myeloma.

Read the full transcript.

For the safety of its patients, staff and visitors, Mayo Clinic has strict masking policies in place. Anyone shown without a mask was recorded prior to COVID-19 or recorded in an area not designated for patient care, where social distancing and other safety protocols were followed.

For more information and all your COVID-19 coverage, go to the Mayo Clinic News Network and mayoclinic.org.

The post Mayo Clinic Q&A podcast: Advances in treating multiple myeloma help extend quality of life for patients appeared first on Mayo Clinic News Network.

Diagnosed with non-Hodgkin's lymphoma in her 40s, Tanis Milicevic tried a number of treatments to keep the disease in check. But the cancer came back. Then her Mayo Clinic care team offered Tanis a new option, and it made a world of difference.

At first, Tanis Milicevic's local doctor told her to wait and see. Pregnant with her second child, Tanis had been sensitive about changes in her body when she felt a worrisome bump on the back of her head.

The doctor's advice gave her temporary peace. The bump was small, and she could just monitor it. Then, after her baby's first birthday, Tanis felt a lump in her underarm. "That's when I knew that something was not right," she says.

Although she felt fine otherwise, her instincts about her health were correct. A biopsy showed she had non-Hodgkin's lymphoma. Tanis and her husband, Marko, learned that while her disease was slow growing at this stage, it also would be hard to cure.

"It was a difficult pill to swallow, but we remained optimistic. You live life and push forward," Marko says. They had to for their sons, 1-year-old Jonathon and 8-year-old Max.

Aggressive disease

Tanis, then 44, underwent radiation therapy  and then chemotherapy for two years. The treatments kept the cancer in remission for five years. That freed her to focus on her family and her business, a women's contemporary fashion boutique.

Then the cancer returned. That's when Tanis decided to go to Mayo Clinic. Under the care of Han Tun, M.D., a hematologist at Mayo Clinic in Florida, Tanis tried two new chemotherapy treatments to manage the recurrence, as well as a second relapse 18 months later. Her cancer was transforming and becoming more aggressive.

At the end of 2017, Tanis reviewed her options with Dr. Tun. It was just a matter of time before the next recurrence. The therapy for this type of cancer usually is a stem cell transplant, but Tanis had no suitable matching donor.

Yet there was still hope. A new treatment has just been approved by the Food and Drug Administration (FDA) for Tanis' type of lymphoma. Known as CAR-T cell therapy, it had been shown to improve remission and survival rates after other treatments had failed. Mayo Clinic had taken part in pivotal clinical trials that led to FDA approval of CAR-T cell therapy, and it was one of the first medical centers in the nation offering the treatment.

In 2018, Tanis became the first patient at Mayo Clinic in Florida to receive CAR-T cell therapy. "I don't think anything could come at a more perfect time for me," Tanis says.

Revolutionary treatment

CAR-T cell therapy, or chimeric antigen receptor-T cell therapy, is treatment that uses a patient's own cells to fight cancer. T cells are a type of white blood cell in the immune system that protect people from infection. In CAR-T cell therapy, T cells are collected from a patient's blood, genetically altered in a lab, multiplied and returned to the patient's bloodstream. The alteration gives T cells the chimeric antigen receptor, which helps T cells recognize, latch onto and kill the intended cancer cells.

"I think that in the past 10 years or so, probably this is the most innovative and revolutionary treatment that our field has seen," says hematologist and oncologist Mohamed Kharfan Dabaja, M.D., director of the Blood and Marrow Transplantation Program and the Human Cellular Therapy Laboratory at Mayo Clinic in Florida.

"(CAR-T cell therapy) has improved the complete remission rate by sevenfold."

Mohamed Kharfan Dabaja, M.D.

What has been exciting to cancer physicians and researchers is how CAR-T cell therapy is helping some patients achieve complete remission, even after other forms of treatments have failed. In complete remission, there are no symptoms or signs of cancer, and the disease is no longer detectable, although it could return later.

"It has improved the complete remission rate by sevenfold," Dr. Kharfan Dabaja says.

When patients achieve complete remission, they have a better chance of surviving. Survival rates two years after treatment are shown to have improved — from as low as 15% to over 50% with CAR-T cell therapy.

CAR-T cell therapy is fast-acting, showing evidence of response within one to three months. It stands out among similar cancer therapies in terms of how it overcomes obstacles — such as vast numbers of cancer cells and suppression of the immune system by cancer — quickly and on its own.

Expanding options

The FDA has approved two CAR-T cell therapies. Presently, both can treat adults with certain types of non-Hodgkin's lymphoma, but only one treats children and young adults, up to age 25, with B-cell acute lymphocytic leukemia. The therapies are used after at least two previous treatments have failed. They are not yet approved for use in earlier stages of the cancers.

Mayo Clinic is one of the few medical centers certified to offer the FDA-approved therapies. Mayo is also one of the few centers to have experience treating patients with the FDA-approved therapies in clinical trials. The treatments are available at Mayo Clinic in Arizona, Florida and Minnesota.

CAR-T cell therapy requires the specialty care that Mayo Clinic provides, especially once the CAR-T cells are infused back into a patient's body, where they release chemicals as they kill cancer cells. The resulting symptoms can be severe.

"These are living drugs," says Yi Lin, M.D., Ph.D., who leads the Cellular Therapeutics Cross-Disciplinary Group at Mayo Clinic Cancer Center. "Patients oftentimes need hospital, even ICU-level, support. They need to be at a very experienced center as they go through the treatment."

Mayo Clinic continues to drive forward new research in CAR-T cell therapy. Mayo is expanding clinical trials with a focus on using the treatment at earlier stages of cancer and in more types of cancer; countering the side effects and safely delivering treatment; and even using CAR-T cell therapy for conditions beyond cancer. Mayo Clinic in Arizona, Florida and Minnesota all will have trials open for various types of blood cancer this year.

Complete remission

Tanis met with Dr. Kharfan Dabaja in 2018, and in late spring, she began the CAR-T cell treatment. Unfortunately, Tanis experienced severe side effects and was hospitalized longer than she expected. That included spending time in the ICU. While it was difficult for Tanis, Marko and their family, the outcome was the result they had hoped for. Six weeks after treatment, Tanis was in complete remission.

"It's given me the chance to live, and I'm forever grateful."

Tanis Milicevic

"This is a patient that had not seen a complete response for many, many years," Dr. Kharfan Dabaja says. "Now she is experiencing a complete response, and with time, her condition has improved significantly, where she's almost back to her normal life."

Tanis reached an important landmark when she was still in complete remission 90 days after her treatment. More than half the patients who reach the 90-day mark will be alive two years later, Dr. Kharfan Dabaja says.

Now, for the first time in a decade, Tanis and her family are thinking of a future without cancer. "Tanis has gone through all the different treatments. This one definitely feels the most amazing," Marko says. "It has allowed me to have my wife and our kids to have their mom."

"It's given me the chance to live, and I'm forever grateful," Tanis says, "My advice for anybody else who has lymphoma is to know that there is hope."

Note: A version of this story previously was published in Mayo Clinic Magazine.

HELPFUL LINKS

• Learn about non-Hodgkin's lymphoma.
• Read more about CAR-T cell therapy.
• Connect with others talking about cancer on Mayo Clinic Connect.
• Explore Mayo Clinic Cancer Center.
• Request an appointment.

The post CAR-T Versus Cancer appeared first on Mayo Clinic News Network.

ANSWER: CAR-T cell therapy uses white blood cells, called T cells, to fight cancer. It’s approved by the Food and Drug Administration to treat several kinds of blood cancer. CAR-T cell therapy typically is reserved for people with blood cancers where the disease has not responded to other cancer treatment.

White blood cells are part of the body’s immune system. T cells are a subtype of white blood cells. They combat threats to the body, such as infections and cancer. CAR-T cell therapy enhances the T cells’ natural cancer-fighting abilities, so they have a more powerful effect on cancer cells.

CAR-T cell therapy involves several steps. First, white blood cells are collected from a patient’s blood through a procedure called “leukapheresis.” Once the white blood cells have been collected, they are sent to a laboratory. There the T cells are modified genetically to strengthen their ability to kill cancer. That part of the process can take several weeks or more.

Before the CAR-T cells are returned to the patient, he or she usually has daily chemotherapy sessions for several days. The chemotherapy is used to make the immune environment in the body more favorable for CAR-T cells to stay alive and be active against the tumor. After that, the patient receives an infusion of the CAR-T cells. The infusion takes about 30 to 90 minutes in a process similar to a blood transfusion.

Once the CAR-T cells go back into the patient’s body, the cells become activated to kill cancer cells. The process of the CAR-T cells becoming activated can trigger significant side effects. Those side effects may include a high fever, fast heart rate, low blood pressure and low blood oxygen. After the infusion of the CAR-T cells, some patients also experience temporary neurologic effects, such as confusion, tremors and difficulty communicating.

Because of the potential side effects, patients may need care in the hospital for several days or more after CAR-T cell infusion, and some may require care in an ICU. After that, ongoing care and monitoring near the treatment facility typically is needed for four to six weeks. Due to the complexity of care associated with CAR-T cell therapy, it’s only offered at medical centers that can provide multidisciplinary specialty care.

Research has shown CAR-T cell therapy to be most effective in treating two types of blood cancers. The first is B cell acute leukemia in children and young adults up to age 25. The second is aggressive B cell non-Hodgkin lymphoma in adults. These are the only kinds of cancer that the FDA has approved for CAR-T cell therapy.

The treatment is not intended for someone who is newly diagnosed. Instead, it’s an alternative for those who already have gone through other more conventional cancer therapy, such as chemotherapy or immunotherapy, and that treatment has been unsuccessful.

A considerable amount of research is underway to see if CAR-T cell therapy could be appropriate as a treatment for different forms of cancer, too, including other blood cancers such as multiple myeloma. So if a patient has a type of cancer that hasn’t responded well to traditional treatment, it may be worthwhile to explore the possibility of enrolling in a clinical research trial that’s using CAR-T cell therapy.

Research at Mayo Clinic and other large academic medical centers also is exploring ways to better manage and reduce the side effects of this treatment, as well as assess the possibility of using CAR-T cell therapy in other diseases beyond cancer. — Dr. Yi Lin, Hematology, Mayo Clinic, Rochester, Minnesota

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• Científicos de Mayo Clinic identifican nuevas estrategias para mejorar terapia de células T con receptor de antígeno quimérico published 12/5/18 (see English version below)
• Mayo Clinic researchers identify new strategies that may improve CAR-T cell therapy published 12/4/18 (see Spanish version above)
• Mayo Clinic first to perform CAR T-cell therapy in NE Florida published 10/9/18

The post Mayo Clinic Q and A: Treating blood cancers with CAR-T cell therapy appeared first on Mayo Clinic News Network.

CAR T-cell therapy begins by collecting a patient’s white blood cells (T-cells) and sending them to a central manufacturing facility, where they are genetically modified to direct them against a patient’s cancer. Once processed, the CAR T-cells are frozen and sent back to the hospital for IV infusion back into the patient.

On the next Mayo Clinic Radio program, Dr. Yi Lin, chair of the Cellular Therapeutics Cross-Disciplinary Group at Mayo Clinic, will explain how CAR T-cell therapy works and where the research is headed next. Also on the program, Dr. Charanjit Rihal, an interventional cardiologist at Mayo Clinic, will discuss treatment and prevention of coronary artery disease. And Dr. Nipunie Rajapakse, an infectious diseases specialist at Mayo Clinic, will share tips on how to help kids avoid common infections.

Here's your Mayo Clinic Radio podcast.

The post Chimeric antigen receptor T-cell therapy / coronary artery disease / kids and infections: Mayo Clinic Radio appeared first on Mayo Clinic News Network.

CAR T-cell therapy begins by collecting a patient’s white blood cells (T-cells) and sending them to a central manufacturing facility, where they are genetically modified to direct them against a patient’s cancer. Once processed, the CAR T-cells are frozen and sent back to the hospital for IV infusion back into the patient.

On the next Mayo Clinic Radio program, Dr. Yi Lin, chair of the Cellular Therapeutics Cross-Disciplinary Group for the Mayo Clinic Cancer Center, will explain how CAR T-cell therapy works and where the research is headed next. Also on the program, Dr. Charanjit Rihal, an interventional cardiologist at Mayo Clinic, will discuss treatment and prevention of coronary artery disease. And Dr. Nipunie Rajapakse, an infectious diseases specialist at Mayo Clinic, will share tips on how to help kids avoid common infections.

To hear the program, find an affiliate in your area.

Use the hashtag #MayoClinicRadio, and tweet your questions.

Mayo Clinic Radio is on iHeartRadio.

Access archived shows or subscribe to the podcast.

Mayo Clinic Radio produces a weekly one-hour radio program highlighting health and medical information from Mayo Clinic.

The post Mayo Clinic Radio: Chimeric antigen receptor T-cell therapy (CAR T-cell therapy) appeared first on Mayo Clinic News Network.

CAR T-cell therapy begins by collecting a patient’s white blood cells (T-cells) and sending them to a central manufacturing facility, where they are genetically modified to direct them against a patient’s cancer. Once processed, the CAR T-cells are frozen and sent back to the hospital for IV infusion back into the patient.

On the next Mayo Clinic Radio program, Dr. Yi Lin, chair of the Cellular Therapeutics Cross-Disciplinary Group at Mayo Clinic, will explain how CAR T-cell therapy works and where the research is headed next. Also on the program, Dr. Charanjit Rihal, an interventional cardiologist at Mayo Clinic, will discuss treatment and prevention of coronary artery disease. And Dr. Nipunie Rajapakse, an infectious diseases specialist at Mayo Clinic, will share tips on how to help kids avoid common infections.

To hear the program, find an affiliate in your area.

Use the hashtag #MayoClinicRadio, and tweet your questions.

Mayo Clinic Radio is on iHeartRadio.

Access archived shows or subscribe to the podcast.

Mayo Clinic Radio produces a weekly one-hour radio program highlighting health and medical information from Mayo Clinic.

The post Mayo Clinic Radio: Chimeric antigen receptor T-cell therapy / coronary artery disease / kids and infections appeared first on Mayo Clinic News Network.