CAR T-Cell therapy helps patient strike back at double-hit lymphoma

UAB’s CAR T-cell therapy cured stage 4 lymphoma with the help of the patient’s resilience and the doctor’s timely diagnosis and treatment.
Written by: Greg Robinson
Media Contact: Yvonne Taunton

Stream Green RibbonUAB’s CAR T-cell therapy cured stage 4 lymphoma with the help of the patient’s resilience and the doctor’s timely diagnosis and treatment. James “Milton” Wilkins, 64, was first seen by doctors near his home in Sylacauga, Alabama, after he was accidentally struck in his abdomen by his grandson’s elbow. The elbow hit came as a blessing and became the event that led to early detection of his rare and aggressive cancer, called “double-hit” lymphoma.

As the cancer progressed, Sylacauga doctors referred him to the O’Neal Comprehensive Cancer Center at the University of Alabama at Birmingham, the only place in Alabama where he could receive an advanced immunotherapy treatment called CAR T-cell therapy. In just over six months, he went from a grim prognosis to remission.

The diagnosis

In June 2019, Wilkins began having occasional pain in his lower abdomen that felt like a knot; but he was not concerned at first. He had had a checkup two months earlier, and his bloodwork was normal. He had almost no family history of cancer either. 

But later that month, things changed when he was watching TV from the recliner with his grandson.

“My grandson went to sit up and just connected with his elbow right where I had been hurting,” Wilkins said. “The pain was unbearable.”

He went to a nearby urgent care clinic, and they conducted a CT scan immediately, discovering a mass in his lower abdomen between the size of a grapefruit and cantaloupe. Following a biopsy test, Wilkins was diagnosed with non-Hodgkin lymphoma. Lymphoma is a cancer that begins in immune system cells. There are two main types: Hodgkin and non-Hodgkin. Non-Hodgkin lymphomas are more diverse and more dangerous. They are generally categorized as either indolent or aggressive. He was not familiar with what lymphoma was, but his wife told him it was a cancer that spreads rather quickly.

Three rounds of chemo

He received his first round of chemotherapy in Sylacauga, though it did not go well as he received two more inpatient chemo treatments in August and September. By then, two new golf-ball-sized tumors appeared on his biopsy scans. 

“This totally disrupted life as I knew it from the beginning,” Wilkins said. “That just made the cancer mad; it came back with a vengeance.”

The doctors referred Wilkins to lymphoma expert Amit Mehta, M.D., associate professor in the UAB Marnix E. Heersink School of Medicine’s Division of Hematology and Oncology, for a third round of chemo. But it did not help, leaving Wilkins dehydrated and leading to 24 hours in the hospital to receive fluids.

“Wilkins had progressed to stage 4 cancer, and we were running out of time,” Mehta said. “He had double-hit lymphoma, a rare type of B-cell lymphoma. His cancer had a genetic component, and it was particularly resistant to chemotherapy.”

Fortunately, UAB Medicine had an innovative treatment option for him called CAR T-cell therapy. T cells, a type of immune cell, can fight the cancerous cells; but they need help.

CAR T-cell therapy involves harvesting a patient’s T cells and modifying their genetics to make the cells search out and destroy cancer cells. The modified cells are put back into the patient with a process known as infusion. Prior to the procedure, patients undergo three days of chemotherapy designed to lower the normal count of T cells to make way for the altered cells.

Providers that offer CAR T services have to abide by strict federal standards. UAB Medicine was among the first group of hospitals certified, thanks to its well-established Blood and Marrow Transplantation & Cellular Therapy Program and Mehta and his colleagues’ participation in clinical trials that led to commercial approval of the therapy.

“The clear effectiveness of this therapy has made it a second-line treatment option after chemotherapy,” Mehta said. “The chances of the cancer’s responding are about 70 percent, and of those, half remain cancer-free for one year or more. Almost all patients with lymphoma that is resistant to chemotherapy are candidates for the treatment.”

Keeping hope alive

Wilkins did not have the best impression of Mehta at first because, “it sounded like I was close to dying,” he said, but he quickly realized Mehta’s honesty, fostering mutual trust. Mehta recommended CAR T treatment, which was costly but effective. Also, Wilkins was only the second person to receive it, so getting approvals from the insurance companies was a challenging process.

“Dr. Mehta and the BMT folks had worked well with our physicians back home and with our insurance companies to get us approved within a week,” said his wife, Cindy Wilkins. “And we were so relieved, because the next closest place for this therapy was Texas.”

During the treatment, Wilkins experienced neurological fog and high fever and was kept under intense monitoring. After five days of neurological fog, the first sign of improvement came while he was still in the hospital, when the lumps on his biopsy scar disappeared. He was shifted to UAB Spain Rehabilitation Center to regain his motor skills, and a week later, he was discharged — with his cancer officially in remission.  

“Dr. Mehta is really a hero to me,” Wilkins said. “The way he kept us fully aware of everything that was going to happen gave us some confidence that it was all going according to plan, and it turned out that CAR T was really the ticket.”