Shashank Cingam, MD
The new approach, called chimeric antigen receptor therapy (CAR-T), uses a modified subset of white blood cells to fight lymphomas, myelomas and leukemias that have failed to respond to more traditional therapy. CAR-T offers new ways to enhance the immune system to treat these cancers.
Shashank Cingam, MD, recently joined the UNM Comprehensive Cancer Center’s Bone Marrow Transplant and Cellular Therapy Team and has helped launch a CAR-T program, which will mean a world of difference for leukemia, lymphoma and myeloma patients in New Mexico.
Cingam and the team successfully completed the first CAR-T infusion in New Mexico in January.
“In several ways it’s similar to a bone marrow transplant, but it’s also different,” Cingam said. “Instead of stem cells, we collect white blood cells. These white blood cells are sent to an outside lab and are modified and multiplied to express receptors that can detect and kill cancer cells.”
The modified white blood cells have receptors on their surfaces that are not otherwise present on white blood cells. These receptors are tuned to find cancer cells and induce the modified white blood cells to destroy them.
In several ways it’s similar to a bone marrow transplant, but it’s also different. Instead of stem cells, we collect white blood cells. These white blood cells are sent to an outside lab and are modified and multiplied to express receptors that can detect and kill cancer cells.
— Shashank Cingam, MD
Although the process collects patients’ own white blood cells, they must still undergo a mild chemotherapy to weaken their immune systems — known as conditioning — to prevent their immune systems from turning against these modified reinforcements.
“Once injected, these CAR-T cells are exposed to the cancer cells, multiply in the body and attack the cancer cells directly, causing killing until there is no more cancer in the body,” Cingam said.
The immune response kicks in right away, he said. But the entire process can take a bit longer.
“Anywhere between one and seven days is when it’s in its full-blown effect,” Cingam said.
As with any immune response, patients will experience side effects, and in this case, they must be strictly monitored.
“These are living drugs,” Cingam said. “Once in your body, they’re not going to take effect and leave. They are multiplying in your body, releasing inflammatory cytokines, which can cause high-grade fevers, or we can see inflammation in or around the brain. So, we give steroids and other anti-inflammatory therapies to limit this inflammation.”
Patients must be watched closely after the procedure, which requires a major time commitment. Right now, New Mexico patients undergoing CAR-T must travel hundreds of miles for treatment, and that means a month-long stay or more out of the state.
“This [therapy] requires patients to spend at least four weeks near the facility,” Cingam said. “Out of those four, they may be admitted only one week. If you go [out of state], they might let you out [of the hospital], but you still have to stick around for another four weeks.”
Having the option of receiving CAR-T therapy in Albuquerque means less travel and fewer obstacles for patients and their loved ones in New Mexico. The UNM Cancer Center Bone Marrow Transplant and Cellular Therapy program currently offers four commercial CAR-T therapies to treat several types of lymphoma and multiple myeloma.
“We can now treat relapsed or refractory diffuse large B cell lymphoma, follicular lymphoma, mantle cell lymphoma, multiple myeloma and acute lymphoblastic lymphoma,” said Cingam. “And, we’re planning to open CAR-T clinical trials in the spring.”
The CAR-T program is part of a broader roster of blood disorder treatments offered at the UNM Cancer Center. That roster includes autologous and allogeneic stem cell transplants and treatment for non-cancerous blood disorders. Cingam has helped the team add the different CAR-T therapies.
And as Cingam and other doctors and researchers around the country learn more about CAR T, it can be used earlier in the course of treatment and lead to better recovery for patients. The UNM Cancer Center has already opened its first CAR T clinical trial using a product that can simultaneously target two different molecules on the surface of cancer cells. Other CAR-T clinical trials are in process.
“CAR-T is much more effective compared to other treatments,” said Matthew Fero, MD, director of the Bone Marrow and Stem Cell Transplant Program at UNM Cancer Center. “It gives patients another great treatment option.”
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