StemCell Therapy

For Kevin Kelley, the bad news came out of nowhere. I woke up one morning, he recalls, and it felt like somebody had stuffed half a banana under the left side of my jaw. The IT data security analyst from the Cleveland suburb of Rocky River, Ohio, considered himself to be in good health, aside from the hypertension that ran in his family and a recent pulmonary embolism that was successfully treated. A competitive swimmer, he swam a couple of miles almost every day, either in Lake Erie or in a pool.

A biopsy of Kelleys swollen gland revealed an aggressive form of non-Hodgkins lymphoma, a malignant cancer that originates in the lymphatic system, a network of vessels, tissues and organs that helps remove toxins and waste from our bodies.

To fight the disease, Kelley and his oncologist, Brian Hill, MD, PhD, of Cleveland Clinic, turned to regenerative medicine not once, but twice. His case is compelling because it highlights where regenerative medicine has been and where regenerative medicine is heading, says Dr. Hill, Director of the Lymphoid Malignancies Program in Taussig Cancer Institute.

Kelley received a bone marrow transplant and CAR-T cell therapy. Bone marrow transplants, which have been used for decades, transfer healthy blood-forming cells into a person with blood cancer. CAR-T cell therapy, which the Food and Drug Administration initially approved in 2017, modifies a patients own immune cells to kill cancer cells.

First, though, Kelley underwent six cycles of chemotherapy. Through it all, he continued to swim as often as he could. His care team even timed the treatments so he and his new bride, Karen, could enjoy a Grand Cayman honeymoon.

Unfortunately, a few months later, a biopsy showed that Kelley wasnt cancer-free. The next step was a bone marrow transplant, immediately preceded by more chemotherapy. Very high doses of chemotherapy are delivered with the intention of eliminating the lymphoma, Dr. Hill says. In the process, though, the patients bone marrow is eradicated, too. So you have to collect their bone marrow ahead of time and then give it back to them after the chemotherapy.

In Kelleys case, the transplant was autologous, meaning he was his own donor. (Allogeneic transplants entail a matched donor.) During the transplant, more than 100 million hematopoietic stem cells were delivered directly into his bloodstream through a special type of IV. For good measure, a chaplain blessed the cells beforehand, at Kelleys request. I figured every little bit helps, he says.

Like salmon swimming upstream to spawn, the cells knew where to go and what to do when they got there, regenerating healthy marrow in the bones.

For Kelley, the road to recovery included a three-week stay in the hospital. After another month of rest at home, he began swimming again, slowly but surely regaining strength. He was declared in remission, although the respite was short-lived. Less than a year after the bone marrow transplant, a scan showed new activity. A lymph node biopsy confirmed it: The lymphoma was back.

Kelley didnt hesitate when Dr. Hill recommended a new line of attack: CAR-T cell therapy. To get the ball rolling, T cells which are white blood cells were collected from Kelley through a procedure called leukapheresis. The T cells were then shipped off to a lab, where they were genetically altered. New chimeric antigen receptors (CAR for short) on the surface of the T cells would allow them to carry out a seek-and-destroy mission against cancer cells. In the meantime, Kelley had another course of chemotherapy. When the manufactured CAR-T cells were ready, hundreds of millions of them were infused into his bloodstream. After a week in the hospital, he was back home and on the mend.

With CAR-T cell therapy, instead of just hammering away at the cancer cells with traditional chemotherapy drugs that poison the cells, the idea is to invoke the power of the bodys own immune response to attack the cancer, Dr. Hill says.

By way of an explanation, Kelley offers an analogy that any fan of old-school video games will appreciate: Suddenly, your body is playing Pac-Man. Once those manufactured T cells are put in you, theyre on the hunt. When they find a cancer cell, they destroy it. Theyre just gobbling it up.

CAR-T cell therapy isnt without side effects, which can include flu-like symptoms as well as neurologic events that can result in confusion. Nonetheless, this particular form of regenerative medicine shows great promise. Im very optimistic for the future of this treatment approach, Dr. Hill says.

As for Kelley, hes back in remission. He plans to swim in a couple of upcoming 8-mile, open-water races: one in the Florida Keys and one around Mackinac Island in Michigan. The latter will be a fundraiser for the Leukemia & Lymphoma Society.

I feel great, Kelley says. Now its time to go have some fun.

More here:
Regenerative Medicine to the Rescue - Cleveland Clinic

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