Vim & Vigor - Spring 2020 - UVA - 8

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Chiminello, however, had some reservations. "I was tremendously apprehensive at
first," he says. There were some unknowns to
contend with: Would the treatment cure his
cancer? Would the side effects be too much
for him to endure? Was it too risky being the
first patient to have this treatment outside of a
controlled, clinical trial environment?
Chiminello sought a second opinion from
doctors at Penn Medicine's Abramson Cancer
Center, the birthplace of CAR T-cell therapy.
What he discovered was that UVA and Penn
Medicine were longtime collaborators in the
effort to advance this promising treatment.
"One of the Penn Medicine clinicians leading a lot of the CAR T-cell trials is in close
collaboration with us, and we have frequently
referred back and forth," Dr. Varadarajan says.
"We've sought his advice on various clinical
cases, and he has been a great resource for us."

PRECISION PUNCH:
SUPER CELLS AT WORK

His knowledge of this partnership-and
his trust in Dr. Varadarajan and Dr. Portell-
gave Chiminello the confidence he needed
to move ahead with treatment close to
home at UVA. The first step: harvesting
his body's T-cells.
"Basically, the T-cells are collected from
the blood and sent to a lab, where they're
turned into 'special forces' that will attack
the cancer but do minimal damage elsewhere in the body," Chiminello says. (For
more, read "Programming Cells to Eliminate
Cancer" at right.)
Before these special fighter cells could
be inserted back into his body, Chiminello
had to undergo intense chemotherapy for
three days to weaken his immune system.
This helps ensure the body won't attack the
newly introduced CAR T-cells before they
can do their job.
The chemo was challenging; reinserting
the CAR T-cells was easy by comparison.
"The process took about 20 minutes, and
there was no pain," Chiminello says. "At that
point, it was just the psychological stress that
took its toll."
Chiminello knew there was a very real
chance his body may respond negatively to
SPRING 2020 VIM & VIGOR

the CAR T-cells. Injecting this huge influx
of hyperactive immune cells is risky and
can cause side effects. The immune system
responds as if you have a bad infection, so
symptoms are much like a bad case of the flu:
fever, body aches and fatigue. This is called
cytokine release syndrome, and it can lead to
life-threatening complications.

ANSWERED PRAYERS

"The doctors had spelled out all of the side
effects for me, so I was prepared," Chiminello
says. He had taken the leap; treatment had
begun. Now all he could do was put his faith
in his care team and the power of prayer.
"I had a group of people across the nation,
family and friends and church members,
all praying for positive results," he says.
"It was uplifting for me, this reminder of
a higher power. And I think my prayers
were answered."
Chiminello did not experience the extreme
side effects he'd been dreading, only a lowgrade fever, which was a good indication that
the therapy was working. After 2½ weeks in
the hospital and an additional 1½ weeks of
close monitoring, Chiminello became a CAR
T-cell success story. "He did not have any
complications, and his scans are all completely
negative," Dr. Varadarajan says.
This positive outcome means Chiminello
can begin planning more trips to see his
daughter and new grandson in Philadelphia.
And it means UVA has a road map for
administering this new treatment to
more patients.
"His experience was important for our
team. It helped us understand how to
manage these patients, how to prepare for
different side effects and, to be honest, it
gave both our inpatient and clinical staff
confidence," Dr. Varadarajan says. "We know
we can do this, and do it well. We are able
to produce the same results as some of the
larger centers."
Chiminello also set an example for patients
to follow. "He's helped a lot of other patients,"
Dr. Varadarajan says. "I have one or two
who are getting the therapy, and they're very
excited and happy for him that he's still in
remission. In that way, he is an inspiration." *

Programming Cells
to Eliminate Cancer
CAR T-cells are manufactured from the body's own
T-cells, which are part of
the immune system. Once
they're collected from the
blood, T-cells are sent to a
processing facility, where
they are inserted with a special gene that has a chimeric
antigen receptor (CAR). The
CAR essentially reprograms
the T-cell so that it seeks
out a particular cancer cell
and destroys it.
It can take three to six
weeks to process CAR T-cells
and get them into fight
mode. Once they're ready,
the cells are injected back
into the body. Within the first
week of injecting CAR T-cells,
they multiply so that a
majority of the T-cells in the
body are now these super
cells that are programmed
to eliminate cancer cells.

Step
Forward
in Cancer
Treatment

Complete remission or
elimination of cancer is
possible for some people
treated with CAR T-cell therapy; however, it's not a cure
for everyone. Understanding
how UVA applies this therapy
and modifies it to help more
people is a critical step forward in advancing cancer
treatment. Learn more at
uvahealth.com/cartcell.
http://www.uvahealth.com/cartcell
Vim & Vigor - Spring 2020 - UVA

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