CAR T-Cell Therapy for Relapsed Leukemia: KaShaun’s Story

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KaShaun spent more than three years of his young life being treated with chemotherapy, which ultimately failed to rid him of his cancer. He’s among a small percentage of children with acute lymphoblastic leukemia (ALL) whose disease is resistant to these powerful drugs.

KaShaun smiling outsideHis parents first learned something was wrong when his dad, Andre, took him to the pediatrician for a routine checkup and immunizations at age 2. Kaisha, his mom, remembers the call she got from Andre that day. “He said he had to take KaShaun to the hospital and that I should meet them there. He told me not to worry, but that he needed some additional tests.”

Of course she worried and rushed to the hospital in Camden, New Jersey. “KaShaun was sitting on a bed. He was happy.” But the news was not good. Blood tests indicated that he had leukemia. He was admitted that day, taken to the intensive care unit and started on chemotherapy. 

Fighting leukemia

KaShaun was in the hospital for three months for his first round of treatment. The leukemia hadn’t made him look or act sick. Kaisha remembers the nurses telling her what a happy baby he was. But the chemotherapy started to take a toll on his body. He tired easily, became weaker and the treatment caused him to gain weight.

The chemotherapy continued for a little more than three years. During that time, the family transferred KaShaun’s care to Children’s Hospital of Philadelphia (CHOP). When the maintenance regimen of chemotherapy ended, 5-year-old KaShaun was in remission. But soon after the treatment ended, his parents knew something was wrong again. He was complaining his legs hurt, and he couldn’t move. The leukemia was back. He relapsed in August 2015.

KaShaun’s doctors explained to the parents that the next step would be more intense chemotherapy combined with radiation. That took an even greater toll on KaShaun’s body, and it scared Kaisha. “He lost his hair. He was being put to sleep every time they did the radiation treatment, and I knew there was a risk from that. I could see that the treatment was hard on him. I didn’t know what to do.”

A new direction

In November, after three months on the intensive treatment regimen failed to get KaShaun’s leukemia into remission, his doctor, Nick Evageliou, MD, in consultation with Shannon Maude, MD, PhD, and member of CHOP’s Cancer Immunotherapy Program, discussed another option with his parents. “They told us they wanted to try something different,” says Kaisha. “They brought up this experimental treatment.” She was skeptical at first, but when she weighed the alternatives — including a bone marrow transplant — she agreed to give it a try.

Preparation for the procedure, called T-cell therapy, began that month through the Cancer Immunotherapy Program at CHOP. Blood was taken from KaShaun so his T cells, a type of immune cell, could be extracted and reprogrammed. The reprogrammed cells would then be able to find and kill cancerous B cells — the cells taken over by his form of leukemia. When the altered T cells were put back into KaShaun, they would expand in his body to eliminate the disease.

CHOP had pioneered the use of chimeric antigen receptor (“CAR”) T-cell therapy in children in April 2012, when Emily Whitehead became the first pediatric patient to receive the treatment. Since then, more than 150 children have been treated with the therapy with largely positive results.

Kaisha and Andre were warned that KaShaun’s body might reject the modified T cells, or that he might have a negative reaction while the treatment took effect. The procedure itself was very simple. They came to CHOP in February 2016 and KaShaun was given an injection of his own reprogrammed cells.

KaShaun had very little reaction, very different from the debilitating chemotherapy and radiation he had received over the previous few years. But gradually, over the course of several weeks, his parents began to see that this treatment had been different in another important way — it was working.

As the T cells did their work and the effects of the chemotherapy began to wear off, KaShaun began to have more energy. He began to look more like himself as swelling from steroids diminished. He wasn’t as pale. And most amazing — tests one month after the treatment showed no signs of leukemia.

A grateful family

KaShaun arm wrestlingKaisha is grateful that the new treatment was available when her son needed it. “When he was younger he would ask me, ‘Am I going to have to go to the hospital for the rest of my life?’ I would just tell him to keep positive. I never treated him as a sick child, and he never pictured himself as sick. He’s a happy kid. He was that way through it all. He is so strong.”

Today, KaShaun has been cancer free for more than a year. His family and medical team are hopeful that his outcome will last, and will watch to see how KaShaun and other children who have been treated with CAR T- cell therapy respond as the years pass. But for now, he’s happily building with Legos, surfing YouTube and pretending to be a superhero. He loves school, too, and is glad his time in the classroom is no longer interrupted by cancer treatment.

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