Cancer patients get second chance at life, thanks to new CAR-T-cell therapy

June 18, 2021
Dr. Brian Hess and William Donevant sit in an exam room
With CAR-T-cell therapy, Dr. Brian Hess is able to offer patients like William Donevant a new lifeline after other treatment options stop working. Photo by Marquel Coaxum

Although it still feels surreal, for the first time in eight years, William Donevant is not on chemotherapy, thanks to a special treatment option for a rare type of non-Hodgkin lymphoma.

Instead, he’s looking forward to a great Father’s Day, doing what brings him the most joy in life, and that’s spending time with his family and his 6-year-old granddaughter.

“Without chemotherapy, it will set me free. We haven’t gone fishing in a while,” he said. “We have gone camping with the granddaughter, but I was limited in where I could go and how long I could be there because I was constantly having to come down to MUSC to get blood checks and see how the cancer was doing.”

William Donevant stands with his wife and granddaughter 
Now that he's in remission, William Donevant is looking forward to spending more time with his wife and granddaughter. Photo provided

Donevant and his wife of nearly 40 years, Jacklyn, had big plans for after they retired. Now she is hopeful that they can actually make those dreams a reality.

“It’s like life is beginning all over,” Jacklyn said. “When William retired at 60, we were planning on traveling. We were going to Europe. We were going to go camping. We were going everywhere.”

William said family is what keeps him going during difficult times, and the 71-year-old has had plenty of hard knocks over the years. He said he feels lucky to be alive today after being diagnosed with stage 4 mantle cell lymphoma eight years ago. The rare cancer can be difficult to treat, but he’s in remission now and credits a groundbreaking treatment called CAR-T-cell therapy at MUSC Hollings Cancer Center for saving his life.

How it works

CAR-T-cell therapy works by collecting a patient’s T-cells, a part of the immune system that focuses on specific foreign particles, and genetically modifying them to express chimeric antigen receptors (CARs) on their surfaces. CARs are proteins that allow the T-cells to recognize an antigen on targeted tumor cells. The cells are multiplied in a laboratory and then infused back into the patient.

The therapy was first introduced at Hollings Cancer Center in 2019. Hollings is the first center in the state with both an adult and pediatric CAR-T-cell program. In 2020, CAR-T-cell therapy was used to treat 14 patients, a number that is expected to grow to 40 to 50 patients in 2021.

Donevant is glad to be part of that group, along with Sharon Carpenter, who was the second patient to receive CAR-T-cell therapy at Hollings. She said she felt lucky to qualify to get it. “It was pretty much my last choice,” she said.

Carpenter, a mother and accounts receivable specialist, was 55 years old the first time she was diagnosed with stage 4 large B-cell lymphoma in her neck.

“I was driving home, and my neck was a little stiff,” Carpenter said. “I reached up and rubbed my neck on the left side, and I felt a lump there. It was like I had a hard rubber bouncy ball in there. And I was like ‘Oh, my God.’”

Carpenter received traditional chemotherapy for six months at Hollings. She had hoped she was in the clear, but in 2019, the lump in her neck returned, accompanied with difficulty eating.

“I made an appointment right away with Hollings because it was in the exact same place,” she said. “I was like ‘Oh, my God, not again.’ I just knew because it felt exactly the same, and I knew it was back.”

She initially received more chemotherapy once the cancer returned, but eventually it stopped working. That’s when Brian Hess, M.D., a Hollings researcher and hematology and oncology specialist at MUSC Health, told her she would qualify for CAR-T-cell therapy.

diagram showing the five steps of the CAR-T-cell therapy process: collect blood, reprogram T-cells, multiply, infusion, CAR-T-cells attack cancer cells 
CAR-T-cell therapy uses a patient's own T-cells to fight cancer and has been successful after other treatment options fail. Adobe Stock

CAR-T-cell therapy does come with risks, as some patients develop serious complications, including changes in consciousness, trouble breathing, increased risk of infection and seizures. Patients are monitored in a hospital setting to monitor any side effects following the treatment. Despite the risks, Carpenter described her hospital stay as very easy.

“Every day, doctors and nurses would come in and check on me,” she said. “I had to write my name and the same sentence a couple times a day. They would do little tests, but I still didn’t have one symptom. Every once and a while, I got a little bit of a headache, but it would go away.”

Donevant wasn’t as lucky, however. He said he was hospitalized for over three weeks after his CAR-T-cell therapy in March.

“I started running a fever, which they told me would happen,” he said. “I don’t remember much about it because I was out of it. As time went on, I got better and stronger, but they still had to give me fluids.”

Hess and Shikhar Mehrotra, Ph.D., co-leader of the Cancer Immunology Program at Hollings, are working on ways to make CAR-T-cell therapy better for patients. Hess said it is rewarding to see some patients have good responses to the groundbreaking treatment.

“CAR-T-cell therapy has been able to provide durable remissions and hopefully a cure to patients who otherwise have extremely poor prognoses,” Hess said.

Hess and Mehrotra are part of a new project at Hollings to manufacture a “purified” version of CAR-T-cells for future patients. They’re hopeful that this new project can reduce side effects and make the treatment more effective.

“Just like we need physicians to see patients and administer CAR-T-cell therapy, we need researchers to be able to manufacture the best possible CAR-T-cell product. They are a vital partner in making this clinical trial available to patients,” said Hess. “They’re also the team with whom we will collaborate to perform the science related to this study to advance the field and inform future studies.”

A shot at a new life

Hess said it’s gratifying to be able to give patients who qualify for this treatment another lifeline. Patients often have exhausted all other treatment options. This was the case for Donevant, an Air Force veteran, who began his cancer journey in 2013 when he noticed swelling under his arm. When medicine prescribed by his primary care doctor failed to help the swollen lymph nodes, he was referred to an oncologist. A biopsy led to his diagnosis of stage 4 mantle cell lymphoma.

In June 2013, Donevant began infusion chemotherapy, alternating between doctors near his home in Georgetown, South Carolina, and Hollings Cancer Center. Initially, treatment was going well. In December of 2013, Donevant said his doctor thought the cancer had gone away. But just four months later, it was back.

“You know, if I had been diagnosed with this thing 20 years ago, it may have killed me. But now with advancements with technology and science, this has made a big difference.”
— William Donevant

“I was like, ‘Oh, man, the stinker is back,’” he said. “It was just like anything else. It is what it is. We’ll just have to see how it goes.”

Between spring of 2014 and February of 2021, Donevant cycled through three different forms of oral chemotherapy. In the end, all of them stopped working.

“The lymphoma was circumventing the Venetoclax,” he said. “The last two oral chemotherapies just didn’t hold it off at all. The Ibrutinib, the first oral chemotherapy, held it off for like five years. But once the cancer circumvents the chemotherapy, that’s it. It’s over.”

Both Donevant and Carpenter are now in remission following their CAR-T-cell therapy at Hollings. They feel grateful for the MUSC doctors and researchers who made the groundbreaking treatment available.

These days, Carpenter lives with family out in Arizona. Donevant is enjoying life without chemotherapy and has planned a long visit to see his daughter and granddaughter. Donevant said he is excited to see how many lives can be saved at Hollings, thanks to this new treatment.

“You know, if I had been diagnosed with this thing 20 years ago, it may have killed me. But now with advancements with technology and science, this has made a big difference,” he said. “I mean, I’ll be 72 years old this year. That’s unbelievable, isn’t it? This, after being diagnosed with stage 4 mantle cell lymphoma when I was 63.”