CAR T Therapy Helps Toddler Emerge Victorious Over Infant Leukemia
“When we got the news, it was just like, ‘How? How?' I felt a pain in my stomach that I had never felt before," lamented Shawanda Prather, remembering the agonizing moment that her then newborn daughter was diagnosed with acute lymphocytic leukemia.
“The day she was born, she had a whole bunch of red patches all over her body. I knew that something just wasn't right,” remarked Prather. In addition to this, little Chasity was suffering from abnormal irritability and frequent vomiting. Her parents suspected that the newborn must be suffering from a serious condition.
Several pediatrician appointments and an emergency room visit later, Kara Kelly, M.D., Pediatric Oncologist for the Roswell Park Oishei Children’s Cancer and Blood Disorders Program, confirmed the parents’ worst fears when Chasity was diagnosed with the particularly aggressive form of blood cancer.
“I happened to be on call the day that Chasity came into the emergency department. You know, she looked grey and was incredibly limp. And when they got the results back, you know, everyone was just astounded,” Kelly said. “A normal white blood cell count for a child is about 10,000, and hers was over 800,000 . . .She really was kind of on the brink of dying. She was that sick. So, we immediately admitted her to the intensive care unit, where we had to resuscitate her and to, you know, really bring her back . . . She was that sick."
The prognosis was grim. Kelly said that the type of leukemia, particularly when presented in infants as young as Chasity, who was only six weeks old at the time, has a mere 20 to 30% survival rate. "This is a five-week-old baby diagnosed with leukemia. How long does she have for her to be at this state?" her father Cariorl Mayfield questioned.
Despite her chances, Chasity’s family and medical team were determined to give her the best possible treatment.
“She might not be herself, but “there’s going to be a light at the end of her tunnel because she always bounces back . . . from day 1,” Mayfield said.
“This is a rare type of leukemia, but in my experience over, you know, the last 25 years or so, I know how bad this is. I've taken care of other children,” Kelly said. “Conventional chemotherapy just doesn't work. So I knew we needed something different. This was kind of the equivalent of a hail mary approach.”
Her medical team determined that Chasity may respond best to CAR T cell therapy, or chimeric antigen receptor T-cell therapy. The treatment was approved by the Food and Drug Administration (FDA) in 2017 and is used to treat patients with advanced blood cancers. Renier J. Brentjens, M.D., Ph.D., of Memorial Sloan Kettering Cancer Center in New York likens CAR T cells to "giving patients a living drug.”
CAR T cell therapy begins when a sample of the patient’s T cells are collected, then altered to produce their own CARS, or chimeric antigen receptors. When the CAR T cells are reintroduced into the patient, they work to destroy tumor cells.
CAR T therapy had yet to be attempted in a child as young as Chasity, however.
“I remember going to bed at 12 or 1 o'clock in the morning, and I just couldn't sleep,” Kelly said. “I, you know, quickly logged into the computer and looked up her labs, and she had turned the corner. Never needed dialysis, never needed to be put on a ventilator. And she just continued to improve.”
Today, Chasity has made nothing short of a miraculous recovery, celebrating her 2nd birthday just a few days ago.
"She keeps me on my feet now from the time we get up to the time we go to bed," Prather said.
Against all odds, Chasity went from less than a 5% chance of survival to over a 90% chance at a normal, healthy life. Kelly confirmed that the toddler was the youngest patient ever treated through this specific type of CAR T cell therapy.
“To be able to do this in such a young patient is really quite, quite remarkable . . . She's thriving, she's growing, she's, you know, a normal toddler. Our goal is not just remission - it's cure,” Kelly said.
Chasity’s story stands in hopeful defiance of a typically grim acute lymphocytic leukemia prognosis. In this case, CAR T cell therapy has proven to be a uniquely viable option.