Following A Patient Story From Transfusion Medicine to Hemepath Rotations
Published by Taylor Jenkins, MD, on November 10, 2016
On the apheresis rotation we not only see patients receiving therapeutic apheresis, but we also see cell collection procedures for various clinical trials and research studies. During the second week of my apheresis rotation, I saw a 31-year-old man who had traveled from the United Kingdom for a special therapy that is only performed in a few academic medical centers in the world.
I walked into the room to see Michael and was quickly greeted by him, his wife, and his mother. I sat down to talk with all three of them to go over his medical history and discuss the procedure that he would undergo in our clinic. They told me that he was initially diagnosed with an aggressive type of acute lymphoblastic leukemia (ALL) two years ago, one month before he proposed to his wife, Kate. He described all of the therapies that he had tried so far, including an allogeneic bone marrow transplant and multiple subsequent donor lymphocyte infusions.
The couple was able to get married but not long after they received devastating news: he had relapsed. He was now receiving multiple monoclonal antibody therapies, but his doctors in the U.K. told him that they had no more treatment options for him. They decided to come to the University of Pennsylvania for a clinical trial where chimeric antigen receptor T-cells specific for CD19 are used to treat various diseases including ALL. My job was to evaluate Michael and make sure he was suitable for cell collection and to answer any questions they would have about the procedure.
Later that night I read an email from my attending, Dr. Don Siegel, who sent me a news story about Michael and Kate. She had raised over 400,000 pounds in only a few days so that they could fly to the U.S. to undergo this investigational T cell therapy. I was incredibly touched by their story. The next day I saw Michael in clinic and this time we were collecting his mononuclear cells for this clinical trial. Everything went well and they told me they were flying back to the U.K. the next day so he could continue with monoclonal antibody injections while his personalized T cells were being made. I wished them luck and told them I probably would not see them when they came back since the infusions are done on the clinical floors.
Around one month later I was told that Michael was back in the hospital to receive the infusion of his personalized cells. He had a bone marrow biopsy prior to his T-cell infusion, which showed 90% residual disease. Four weeks after his T cell infusion he had an additional bone marrow biopsy to see if the therapy was working. I happened to be on the Hematopathology rotation at the time. I saw his name pop up on our queue and hoped that this would be good news for him and his family.
When I received his slides I carefully looked them over again and again. I did not see anything suspicious but ordered immunostains to look for blasts to be certain. I reviewed the case with my attending, who agreed that there was no residual ALL. I could not believe it—only two weeks into this new therapy and there was no disease when just a few weeks ago his bone marrow was packed with ALL cells. I wished I could go tell Michael and his family myself that his disease was gone. A few days later I saw that he was doing well and that his clinical team had discharged him from the hospital.
When I started my pathology residency, I never expected to have such a moving patient experience. I am so thankful that I was able to participate in the care and diagnosis of Michael. Even though I never got the chance to see them again after his cell collection, I hope he and his family know that I have been thinking about them and rooting for them the whole time.
Taylor Jenkins, MD, is a second-year resident in the combined Anatomic Pathology & Clinical Pathology Program and a graduate of the Medical University of South Carolina College of Medicine.
Disclaimer: The views and opinions expressed in this blog column are those of the authors or other attributed individuals and do not necessarily represent the official position of the Department, Penn Medicine, or the University of Pennsylvania. Health information is provided for educational purposes and should not be used as a source of medical advice or diagnosis.
Image: A post by Michael’s family announces the results of the bone marrow biopsy on Facebook.