By Shauna Mazenes
Allan Pearson never imagined getting a life-threatening diagnosis.
As a man who seemed perfectly healthy, he spent most of his days hiking, wind surfing, or chopping wood on his farm home in British Columbia. It came as a shock to him and his wife when just over a year ago he was told he had advanced-stage aggressive large B cell lymphoma.
"The irony was I had just turned 75," Allan says.
“I remember I had been asking myself: what else can I achieve before I turn 80?"
A cross-country journey to receive a life-saving CAR-T cell treatment at Princess Margaret Cancer Centre has allowed him to continue asking that question.
"There's still more to do in my life," Allan says. "This procedure absolutely saved me."
Now, more patients such as Allan will have access to this treatment at the Princess Margaret. Cancer Care Ontario recently expanded its eligibility criteria for CAR-T cell therapy as a treatment for patients suffering from lymphoma and lymphoblastic leukemia in or outside of the province.
Built on the discovery of the T cell receptor by Dr. Tak Mak of the Princess Margaret in the 1980s, CAR-T cell therapy is a treatment where a patient's immune cells are removed, enhanced in a lab, then returned to their body in hopes of attacking the cancer.
The Princess Margaret has been performing CAR-T on patients for five years, curing between 30 per cent and 40 per cent of their disease. Last year, 73 lymphoma patients were treated, 27 of whom were from outside Ontario.
The program is led by Dr. Christine Chen, Head of the Immune Effector Cell Program at UHN.
According to Dr. Michael Crump, a hematologist at the Princess Margaret, CAR-T cell therapy can make the difference between a patient having a potentially curable disease, or an end-of-life condition and palliative care.
"By and large, our CAR-T patients are those with high-risk disease that isn't curable by anything else," says Dr. Crump.
Another unique aspect about the procedure is that, unlike other cancer therapies, CAR-T is a single treatment that takes about a month, he adds.
"Then the fight between the patient's immune system and the lymphoma stops," Dr. Crump says. "And, we wait and see if the cancer comes back."
'We were at the end of our road'
Allan, who was diagnosed while on vacation in Mexico, didn't have many options. By the time he found out what he was dealing with, the cancer had spread all over his kidneys and was causing renal failure.
He caught an emergency flight back home to B.C., where two rounds of chemotherapy failed.
It was then that his oncologist referred him to Princess Margaret Cancer Centre, in hopes of qualifying for CAR-T. He remembers walking into the office with his wife for the first time.
"I was quite full of cancer," Allan recalls. "Everyone was shocked by how advanced I was."
His wife, Genisea, remembers the look on the doctor's face.
"I told the doctor 'look, I know it's a gamble to take us on, but we have no choice,'" she says.
"We were at the end of our road."
Then began a strenuous journey, with many bumps along the way.
For the procedure to work, a patient needs to have functioning kidneys to dispel the chemotherapy drugs given prior to the CAR-T cell infusion in the body. Allan needed to have two stents put in his kidneys leading into his bladder to open blockages the cancer was causing.
The nurses then harvested his T cells from the blood, a process which took just over five hours. They were sent to a lab in New Jersey where they were programmed to attack cancer cells, taking approximately three weeks.
Once the T cells came back – fully equipped and ready to fight – they were reintroduced into his body, the point at which a patient's life can change for better or for worse.
Genisea remembers watching the process unfold, seeing Allan's cells being taken out of the package they arrived in, then circulated in a machine before they were put into his IV.
"It was like watching a baby being born," she says. "It was like seeing something come to life.
"Even the nurses were so excited because they knew that this is hope. This is saving someone's life."
'He was going downhill so fast'
For a month, Allan's immune system was low and he was closely monitored by his care team at the Princess Margaret. The first set of scans done to assess the response to CAR-T treatment showed significant improvement.
Dr Crump was optimistic that further improvement would follow three months to six months later.
Allan has since gone back to Vancouver where he's being watched by his doctors. The T cells can work up to two years and are expected to keep fighting in his body.
He continues to be active and is slowly regaining his strength, while spending valuable time with his wife and son.
"I had a lot of cancer," Allan recalls.
"He was going downhill so fast," Genisea adds.
'I've been given a new lease on life'
Both Allan and Genisea remember the grave looks on the faces of the doctors who initially assessed him.
But when they saw Dr. Crump after the procedure, he had a big smile on his face.
"I had done well," Allan says.
"I've been given a new lease on life."
Allan and Genisea credit their success story to Dr. Crump and all of the amazing staff at the Princess Margaret who helped them along the way.
"The amount of care and love we received here was phenomenal," says Genisea.
"It was unbelievable how good the team was," Allan adds. "They were beyond five stars.
"What a fantastic treatment."
