Creating Cancer-Killing Cells & Preparing Patients For Battle

After six cycles of chemotherapy, Ann Uhar finally heard the word “remission,” but the 69-year-old Carmel, Indiana, woman couldn’t claim that title for long.

A few months later, her lymphoma was active again, a common occurrence for leukemia and lymphoma patients

Thankfully, Ann lives near one of only two centers in Indiana providing chimeric antigen receptor (CAR) T-cell therapy, a form of immunotherapy in which a person’s own white blood cells, called T-lymphocytes, are extracted, engineered to recognize and destroy cancer cells and returned to the patient.

The Indiana Blood and Marrow Transplantation (IBMT) program at Franciscan Health Indianapolis specializes in hematological disorders and cancers, including acute leukemia, Hodgkin or Non-Hodgkin lymphoma, multiple myeloma and other malignant blood disorders. The IBMT usually joins a patient’s battle when the first line of treatment has failed or when they need a transplant.

Luke Akard, MD, hematologist and bone marrow transplant physician, said Franciscan Health's IBMT program is a leader in CAR T-cell therapy, leading its early clinical trials, offering it beginning in 2016 and participating in continuing research. assessing patients’ overall health and creating an individualized program to make sure they are in the best shape possible when their treatment begins. The program continues throughout their inpatient stay and after.

Uhar had her CAR T-cell infusion in November and was hospitalized for 10 days. Because the potential side effects are serious, a patient must be under constant supervision for the first 14 days and reside within an hour of the facility for the first 30 days. The IBMT program works with referring physicians around the state to help patients reside in or near Indianapolis during key parts of their care, then coordinates their follow-up care closer to their home.

'Prehab' Is Key

Because these cancers are particularly hard on a patient, and because patients are often older and less physically able to endure them, the practitioners at IBMT felt another piece was needed in order to set patients up for success. They call it ‘prehab’ and liken it to training for a race.

“With cancer treatment, the disease itself is a process that burns up your energy and wastes away your muscles and chemotherapy does the same to you,” said Felix Mensah, MD, a bone marrow transplant physician who serves as co-director of IBMT’s cellular therapy and transplant program.

Dr. Mensah, along with Lead Physical Therapist Macy Hogan, PT, DPT, spearheaded a program created to help patients fighting blood disorders and cancers optimize their battle. Known as the Transplant Optimization Program (TOP), the concept involves assessing patients’ overall health and creating an individualized program to make sure they are in the best shape possible when their treatment begins. The program continues throughout their inpatient stay and after.

As part of the preparation for getting the CAR T-cell infusion, Ann met Dr. Hogan, Transplant Optimization Program co-creator and a specialist in oncology and immunocompromised patients. Dr. Hogan who assessed Ann's overall activity, strength and endurance and prepared a regimen to help her train for her treatment.

“It really changes people’s ability to get back to their normal lives sooner,” Dr. Hogan said. “I do the same battery of tests before transplant or CAR T-cell therapy and after and compare the two. Those who have been through pre-habilitation do much better. I’ve even had patients who tested better than before they went through transplant.”

Outcomes Prove Prehab Works

Dr. Akard said Franciscan Health's Transplant Optimization Program is a big reason the IBMT’s outcomes are so successful.

“In order to ensure that patients can get through such aggressive treatments, we’ve had to focus on trying to enhance how patients will do, not just in terms of getting through the treatment but even becoming a candidate for the treatment,” Dr. Akard said.

He said colleagues in physical therapy, occupational therapy and speech therapy have been receptive to the idea of having a transplant-focused method to enhance outcomes.

“So far it has been an important addition,” Dr. Akard said. “It is part of the reason we’re having good outcomes.”

Dr. Akard said between 2019 and 2021, Franciscan Health's transplant program was in the top 13 in the country and in the top three for outcomes.

Ann believes TOP is making a difference in her fight against lymphoma, which is once again in remission. She said she thinks of her newly infused T-cells as little soldiers engaged in battle.

“I talk to my T-cells,” Ann said. “I talk to them every night. I go, ‘You guys are doing good work. Keep reproducing. Just keep doing your good work.’”