Unmet needs and the science of cell therapy
By Tamer Akl; Regional Medical Director at Gilead and Kite Oncology
Lymphoma is the most common blood cancer1. It affects the lymphatic system, developing in lymphocytes (the white blood cells that help to fight infection). Lymphoma is categorised into two groups: Non-Hodgkin’s lymphoma, which comprises approximately 90% of all lymphomas, and Hodgkin’s lymphoma2.
Non-Hodgkin’s lymphoma (NHL) is the most prevalent haematological malignancy in the world, with an estimated 544,000 new cases identified in 2020. Unfortunately, the numbers are growing each year3.
There are about 60 different types of NHL, with most forms developing from B cells4. Diffuse Large B-cell lymphoma (DLBCL) is the most common aggressive non-Hodgkin lymphoma subtype and because of its rapidly progressive nature, there exists an unmet need for its treatment, including in the Middle East5.
Frontline treatment of LBCL currently lies with R-CHOP, however, around 30-40% of patients with LBCL will relapse or become refractory to R-CHOP and of these, only half will progress to definitive therapy with high-dose chemotherapy and stem cell transplantation6. And for those that do undergo transplantation, 80% do not achieve long-term remission. The human dimension of these stark statistics is distress and anguish for LBCL patients and their families. One treatment that is coming to the fore in the fight against DLBCL is Chimeric antigen receptor (CAR) T-cell technology. This therapy harnesses the body’s immune system to fight cancer. The chimeric antigen receptors are engineered proteins that are added to a patient’s cell, enabling it to recognise cancer cells. Cell therapy is a complex, specialized procedure with several stages. First, the suitability of the patient to receive the therapy must be assessed, with the physician determining factors that include underlying health conditions and co-morbidities. After suitability has been confirmed, the patient’s white blood cells are extracted, and the T cells separated. Once isolated, the T cells are genetically engineered to gain the chimeric antigen receptor, which helps them recognise and target cancer cells. These modified T cells are then infused to the patient. The patient requires close observation during the reintroduction of the cells to observe for potential side effects. As with all forms of treatments, Cell therapy is not without its risks. However, recent advances in the field have reduced the risk of complications7.
Boundaries are continuing to be pushed with Cell therapy. Currently, the procedure is autologous, meaning that it involves one patient receiving their own cells back, making this a highly individualized treatment.
Treatments such as cell therapy are offering the possibility of unlocking new ways to treat cancer.
References:
1. Lymphoma Research Foundation. What is lymphoma? Available at: https://lymphoma.org/aboutlymphoma/. Accessed: February 2021.
2. Lymphoma Research Foundation. What is lymphoma? Available at: https://lymphoma.org/aboutlymphoma/. Accessed: February 2021; Batra R, Kaur H, Jindal S. Extranodal large B-cell type agressive non-Hodgkin’s lymphoma. Indian Journal of Dentistry. 2014; 5(4):225-228.
3. Global patterns of Non-Hodgkin Lymphoma in 2020. Int J Cancer. 2022 Nov
Leukemia & Lymphoma Society. NHL subtypes. Available at: https://www.lls.org/lymphoma/non-hodgkin-lymphoma/diagnosis/nhl-subtypes. Accessed: February 2021.
5. Al-HamadaniM, HabermannTM, CerhanJR, et al. Am J Hematol. 2015;90(9):790-795.
6. Relapsed or Refractory Diffuse Large B-Cell Lymphoma: “Dazed and Confused” (cancernetwork.com)
7. https://www.cancer.gov/news-events/cancer-currents-blog/2020/car-t-cell-therapy-lymphoma-reduced-side-effects#:~:text=While%20the%20therapy%20can%20lead,can%20be%20severe%20or%20fatal.
