Fighting Cancer Cell by Cell

The AHN Cancer Institute’s Division of Hematology and Cellular Therapy is home to expert physicians who specialize in the timely diagnosis and advanced treatment of blood cancers.

The team offers CAR T-cell and other forms of immune effector cell therapy, such as tumor infiltrating lymphocytes (TIL) therapy, T-cell receptor T-cell therapy (TCR-T), stem cell transplantation, and immunotherapy. Due to the unique needs of patients with these types of cancer, most of the division’s specialized services are housed at AHN West Penn Hospital.

“Our collaborative approach includes an experienced and specialized team of hematologists, pathologists, radiation oncologists, and other clinicians who collaborate to provide our patients with personalized treatment plans for the best possible results,” said John Lister, MD, Chief of the Division of Hematology and Cellular Therapy.

The Foundation for the Accreditation of Cellular Therapy (FACT) establishes the bar for excellence in hematopoietic stem cell transplantation and immune effector cell therapy for the treatment of leukemia, lymphoma, myeloma, and other malignant diseases. The AHN Cancer Institute’s Division of Hematology and Cellular Therapy is FACT-accredited for both transplantation and immune effector cell therapy, placing it among an elite group of programs nationally and internationally.

Pioneers in CAR-T cell therapy

Clinicians at the AHN Cancer Institute have long been leaders in CAR T-cell therapy. Since 2019, they’ve been pushing aggressive blood cancers into remission by infusing these reengineered T-cells into patients. Now, rather than shipping patients’ cells to an outside lab for the manufacturing process, AHN has invested in sophisticated equipment that can produce these cells at AHN West Penn Hospital.

“Having this technology here at our facility gives us a potentially lifesaving treatment for a patient who desperately needs something quickly,” said Dr. Lister. “With CAR T-cell therapy, we can alter a patient’s own immune cells — one patient at a time — and then tell the cells, ‘Go find the cancer cells and wipe them out.’ This is truly a new dawn for cancer therapy and for personalized medicine.”

Transforming a patient’s own cells to fight cancer

The immune system allows the body to recognize which cells are its own and which are not, killing off any foreign cells lurking in the body. But when someone develops cancer, especially blood cancer, the immune system can no longer recognize the cancer cells as foreign. And the more the cancer establishes itself, the more the disease develops ways of evading the immune system and the T cells seeking to eliminate it.

But experts at AHN are finding those cancer cells. Using CAR T-cell therapy, they can successfully fight some of the most challenging cancers, like leukemia and lymphoma. It could even turn a patient’s otherwise terminal diagnosis into a chance at remission.

“The therapy involves connecting patients to a machine that spins their blood and collects the T cells,” Dr. Lister explained. “Then AHN scientists genetically reprogram these T cells in the laboratory by equipping them with chimeric antigen receptors (CARs) that enhance their ability to recognize cancer cells and kill them.”

The genetically modified T cells are incubated in the laboratory until they multiply into millions. Typically, eight days after the cells were originally removed from the patient, doctors infuse the reengineered cells back into the patient. The CAR T-cells begin their mission, traveling throughout the body to eliminate cancer cells. It is a one-time infusion, although patients may remain in the hospital for several weeks to monitor their response to treatment and side effects.

On-site capabilities broaden treatment potential

AHN offers commercially available CAR T-cells for lymphoma, myeloma, and acute lymphoblastic leukemia. These cells are manufactured at a centralized facility and often take four to six weeks or longer to make it from collection to infusion. They are received frozen and must be thawed before they can be infused into the patient. Thawed cells take time to recover from the effects of freezing.

“Patients who are candidates for CAR T-cell therapy have aggressive disease for which other forms of therapy are ineffective and often more toxic,” Dr. Lister said. “Frequently, time is critical, and having the ability to produce the CAR T-cells on-site and infuse them into the patient eight days later is extremely beneficial.”

Dr. Lister explained that AHN’s on-site capabilities also widen the institute’s opportunity to treat more patients through research protocols. Currently, CAR T-cell therapy is FDA-approved as a standard of care for some forms of aggressive, refractory lymphoma, such as diffuse large B cell lymphoma, transformed follicular lymphoma, and mantle cell lymphoma. This therapy is also approved for patients with relapsed or refractory acute lymphoblastic leukemia.

Recently, two products have been approved for treatment of multiple myeloma. The treatment is provided at AHN West Penn Hospital and is available to any patient meeting the criteria for treatment.

“Research is fundamental to improving existing therapy, expanding eligibility for treatment and extending the frontier to other forms of cancer and autoimmune disease. At AHN, we are singularly focused on translating promising laboratory research to the clinic,” Dr. Lister said.

“And we are on the verge of introducing novel TIL therapy to the clinic for malignant pleural effusion due to breast cancer and other forms of solid tumors. These are the early days of this revolution in cellular therapy, and AHN is fully committed to it.”