Leukemia is one of the most common types of cancer found in Sri Lanka, especially amongst children. A recent discovery in immunotherapy to treat blood cancers and non-haematological cancers is proving to help treat leukemia patients. This breakthrough treatment which is known as Chimeric Antigen Receptor or CAR T-cell Therapy could potentially lower the death rates of blood cancer related patients.
The latest World Health Organization (WHO) data published in 2020, ranked Sri Lanka in the World Rank 35th position due to the death rate attributed to leukemia. The report stated that the number of deaths from leukemia in Sri Lanka reached 1,155 or 0.99% of total deaths in 2020.
CAR T-cell Therapy is the latest treatment approved to be delivered commercially by the U.S. Food and Drug Administration (FDA) and the Singapore Health Sciences Authority (HSA) under a new Cell, Tissue and Gene Therapy Products (CTGTP) regulatory framework. Parkway Cancer Centre (PCC) is the first private medical centre in Singapore to offer this treatment.
It involves extracting a type of white blood cells in the immune system called T-cells from the patient’s blood, and modifying them in a laboratory to enable them to recognize certain targets on certain cancers. The modified T-cells (CAR T-cells) are then reinfused into the patient to detect cancer cells and destroy the cancer by harnessing the body’s own immune response.
CAR T-cell Therapy is currently approved for the treatment of B-cell Acute Lymphoblastic Leukemia (B-ALL), leukemia in children and young adults up to the age of 25, and relapsed and refractory cases. Patients who are responsive to treatment also continue to be stable and free of disease, with 7 out of 10 patients surviving after 2 years.
The eligibility for CAR T-cell Therapy is assessed based on some factors including overall fitness of the patient to receive lymphodepleting chemotherapy to prepare the body to receive CAR T-cells, adequate organ functions (heart, lungs, kidney, liver) to be able to handle treatment, the age limit of up to 25 years, and absence of ongoing serious infections, concurrent cancers and active autoimmune disorders.
Like any other treatment, CAR T-cell Therapy can lead to side effects such as Cytokine Release Syndrome (CRS), which is a multisystemic disease, immune effector cell-associated neurotoxicity syndrome (ICANS), tumour lysis syndrome and other complications like low immunity levels and higher risk of infection. However, these side effects can be managed by a highly trained, multidisciplinary clinical care team which ensures continuity of care. Patients will be monitored for efficacy, response and side effects for a period of time following treatment.
The treatment offers a significant survival advantage compared to conventional chemotherapy. The high overall success rates in achieving remission with CAR T-cell Therapy is testament to the extensive, groundbreaking advances in medical research and technologies in the field of Haematology over the years.