An NCI-designated Comprehensive Cancer Center
By Dory Benford | June 27, 2019
Tyler Routh | City of Hope CAR T cell therapy success story Tyler Routh, left, with his physician, Samer Khaled, M.D.
 
CAR T cell therapy can achieve partial or complete remission in patients with acute lymphoblastic leukemia about 80 percent of the time. But a number of these patients experience side effects such as cytokine release syndrome and neurotoxicity. 
 
Samer Khaled, M.D., associate clinical professor in the Department of Hematology & Hematopoietic Cell Transplantation at City of Hope, said he may have found a CAR T product that is more potent and less toxic — a potential game-changer if the results of his ongoing phase 1 clinical trial hold through future testing.
 
Tyler Routh is one of 13 leukemia patients who had a remarkable recovery after participating in Khaled’s CAR T trial.
 
The clinical trial enrolled 16 patients with relapsed or refractory B cell acute lymphoblastic leukemia, a disease that has less than optimal survival rates. Investigators used a unique manufacturing platform developed at City of Hope that generates therapeutic cells from enriched memory and “naive T cells” — immune soldiers known for their capacity for long-term persistence.
 
Thirteen out of 13 patients evaluable for response received the treatment and are in complete remission, showing a 100 percent response rate with no significant increase in toxicity. One of those patients is Routh.

The Road to City of Hope

In January 2014, Routh was diagnosed with acute lymphoblastic leukemia.
 
“I had some back pain that got progressively worse with weakening legs and numbness. My chiropractor was getting me set up for an MRI, but it wasn’t going quickly enough. Eventually, I could not get around without a cane, then within a week, I was using a walker and then couldn’t get out of bed,” Routh recalled.
 
“An ambulance had to take me to the emergency room, where I had an MRI done. After that, I went into surgery to have a tumor removed from my spine. There was no guarantee that I would walk again at this point, and I hadn’t even been diagnosed with cancer yet. The tumor samples were sent to the lab for a few days, and that was where they found my diagnosis.”
 
After his surgery, Routh underwent more tests, radiation and chemotherapy. He also began physical therapy and had to learn how to walk again. Despite these challenges, he was pronounced cancer-free and went on with his life, only for the cancer to come back in 2016.

The Relapse

“I had been cancer-free for almost two years. Then, I started experiencing some weird muscle spasms in my legs. Nothing seemed off on my bloodwork, so I was thinking it was just a pinched nerve or something. I got an MRI and visited my surgeon to see if he could find anything going on. He wanted a better MRI, but before my scheduled scan I ended up in the emergency room again,” Routh said.
 
“After some testing, we discovered that I had relapsed and this time it was in the marrow.”
 
Routh went through chemo again, but this time, it didn’t work as well as he had hoped. That’s when his care team began considering clinical trials. Like many patients, Routh was nervous about taking this step.
 
“There were talks of clinical trials, and those words scared me more than cancer and chemo did originally, but it led me to City of Hope. CAR T cell therapy was the new trial that seemed promising for my situation, and I fit the criteria perfectly,” Routh recalled.
 
“I was nervous at first to get used to a new, bigger hospital, but now it feels welcoming, like a second home. It’s such a nice campus with an amazing staff. I visit the koi pond every time I have an appointment.”
 
In addition to feeling at ease at City of Hope, the efficacy of his CAR T treatments was also a pleasant surprise.
 
“I had my infusion on Nov. 28, 2016, and at my 30-day scan and bone marrow biopsy, I was cancer-free. I still am to this day,” Routh said.
 
Now, Routh is waiting for just one more piece of good news from his doctor.
 
“I still haven’t had sashimi, poke or oysters in over two years and I’m really hoping to get approval to eat that again from the doctor soon,” Routh said.
 
Sushi aside, Routh’s cancer battles have also resulted in some nerve damage to his feet that is permanent. He also struggles with the feeling that his life was placed on pause for a couple years. Overall, however, this experience has given him a positive outlook on life.
 
“This process has taught me a lot about health care, medicine and science. It’s also made me focus on my health a lot more and reminded me to do the things you want to do before it’s too late.”
 
Thanks to CAR T cell therapy, Routh now has plenty more time to live his life to the fullest.
 
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