Sandra Davis-Quinney has been met with bumps, curves and stops on the ride that is her cancer journey. Even with the rough roads she’s endured, Sandra tries to stay hopeful, resiliently staying on the ride.
Staying on the ride is exactly what brought her to UF Health Cancer Center’s Jack Hsu, M.D.
After failing multiple rounds of chemotherapy from 2017 to 2019 in an effort to treat her non-Hodgkins lymphoma, Sandra’s next option was a stem cell transplant. However, when her physicians were unable to collect enough stem cells for a transplant, that option was taken off of the table. Heading home to Jacksonville to get back on medication and let her body “get itself together,” Sandra met with her UF Health Jacksonville oncologist, Joseph Mignone M.D., and began looking into other available options.
When she learned about the novel chimeric antigen receptor (CAR) T-cell therapy, a genetic therapy that modifies the patient’s own cells to attack their cancer, at UF Health, she knew her ride was just gaining momentum. Sandra was a candidate for the treatment, but she wasn’t just any candidate – she was the first CAR T-cell patient at UF Health.
Hsu and his UF Health Bone Marrow Transplant Unit team spent two years preparing to become certified as a CAR T-cell therapy site – developing policies and procedures, building relationships with subspecialties and earning an accreditation for their stem cell lab. In October of 2018, UF Health became a designated site for administering the therapy.
“This is the first genetic therapy that was approved for the treatment of adult hematologic malignancies” Hsu said. “It provides another option for patients who have very high risk lymphoma.”
The reality of being the first CAR T-cell patient at UF Health didn’t sink in for Sandra until the process was set in motion, she said. She had heard about different trials and new treatments, but now she was the star of the show in one.
“Being the first patient is a big deal,” she said. “If it affords other people the opportunity and the availability is here for them, then that’s great.”
The initial extraction of her cells wasn’t what she expected. Preparing for a more invasive and painful procedure, the procedure ended up being more like drawing blood.
“You feel different in your body because naturally they extract the blood, extract what they need from the blood and put it back into the body,” Sandra said. “I was freezing cold, but it wasn’t painful.”
Going through the actual CAR-T cell therapy was a different story. Because she had been through multiple rounds of chemo, the therapy itself wasn’t too bad.
“It was not pleasant at times, but it wasn’t really bad until I went through the process of where I had to go to the intensive care unit,” she said.
There are two major side effects to the treatment – cytokine release syndrome, which causes the patient to develop swelling and their blood pressures to drop, and neurotoxicity, which causes changes to the patient’s mental status, Hsu said. Sandra developed both.
“Getting her through that, since we didn’t have practical experience before this, was very exciting because although we knew what to expect, actually seeing it was a different experience,” Hsu said.
Due to the neurotoxicity she developed, Sandra doesn’t remember the week she spent in the intensive care unit. For days, she was coherent and talking, but there’s a gap where the memories of those days should be.
Although her body is still adjusting to life after CAR T-cell therapy, a recent evaluation, three months after her therapy, revealed the news Dr. Hsu, Sandra and her family started this journey to hear – her lymphoma is in complete remission.
“No pain, no gain,” Sandra said. “I just do what I need to do and live life as a happy day every day.”
Hsu said treating the first CAR T-cell patient at UF Health was scary yet exciting. He was confident in the policies and procedures he and his team spent years perfecting.
“I’m happy to say that because we spent some time ironing out the details and trying to figure out potential points of failure, we didn’t really have much of a problem,” he said.
The CAR T-cell therapy program at UF Health opens doors to new opportunities for patients, physicians and researchers. Now, UF Health can participate in CAR T-cell-specific trials and work with pharmaceutical companies to target other diseases.
“Developing this program gives us the ability to participate in trials of this class of therapy because not all facilities are going to be able to do this,” Hsu said.
CAR T-cell therapy is in active investigation, not only for other blood cancers like multiple myeloma but also solid tumors like colon cancer. These treatments will become an important therapeutic option for patients like Sandra, especially as similar therapies are further designed and explored.
The accessibility to novel treatments like CAR T-cell therapy is why Sandra chose UF Health. While her cancer journey hasn’t always been smooth, her determination to stay on the ride led her to the finish line.
“There are challenges. There’s days that I’m disappointed with what my counts are but I don’t let it discourage me,” she said. “I keep praying, driving, putting fuel in my tank and propelling forward.”