In the two decades since I was diagnosed with WM, I have seen many changes in the treatment of our disease. Back then, my conventional treatment options were pretty well limited to cyclophosphamide or fludarabine. Rituximab treatment was reserved for those who had relapsed. How the times have changed! And the future holds even more promise with new and upcoming therapies.
One of the most exciting developments is CAR T-cell therapy, which is being used, successfully, on WM patients in clinical trials and is considered to be potentially curative. Unfortunately, Canadian lymphoma CAR T-cell trial sites in Ottawa and Vancouver (NCT03765177) are currently only accepting high risk and aggressive lymphomas. This excludes WM at the moment. But as CD19 and CD22 are the primary target sites of CAR T-cell transplantation, WM is well suited to be included in future trials.
CAR stands for chimeric antigen receptor. Essentially, this is an autologous transplant with a twist. Rather than harvesting stem cells, the target group is T-cells. But instead of simply reinfusing them after high dose chemotherapy, the T-cells are taken off to the lab where they are re-engineered with a more selective targeting system. Weeks later, these T-cells are reinfused after mild chemotherapy to reduce the patient’s lymphocyte count and make room for the newly engineered T-cells to expand. The link below tells the story of one WM patient who successfully underwent CAR T-cell treatment for WM transformation to DLBCL at Columbia University, in New York.
For those who want a more detailed description of CAR T-cell therapy, the National Institute of Health in the US provides a simple, patient-friendly explanation. The link is:
https://www.cancer.gov/about-cancer/treatment/research/car-t-cells