Acute Lymphoblastic Leukemia Treatment With CAR-T

Acute lymphoblastic leukemia (ALL) is an aggressive disease. Although ALL can develop at any age, it is the most common cancer diagnosed in children. As an extremely fast-growing malignancy of the blood and bone marrow, ALL requires treatment be administered as early as possible for a positive outcome. When left untreated, the disease can become fatal within months. Treatments for ALL include chemotherapy, targeted therapy, radiation therapy and bone marrow transplants – and at the forefront of the field is acute lymphoblastic leukemia CAR T-cell therapy.

A Source of Hope – CAR T-Cell Therapy in Israel

Groundbreaking CAR T-cell therapy is offered at only a few places worldwide, one of which is Sheba Medical Center in Israel. Specially trained, world-renowned cancer experts at Sheba’s Hemato-Oncology Division collaborate to evaluate each case of ALL and design the most effective treatment program. In fact, when it comes to treating ALL patients with CAR-T therapy, Sheba is the most experienced center not only in Israel, but also in Europe. 

How This Specific Blood Cancer is Treated with CAR T-Cell Therapy?

Standard therapies, such as chemo and radiation, often fail to eradicate all types of ALL. However, acute lymphoblastic leukemia CAR-T has been successful at putting some people’s cancers into remission. Pioneering CAR T-cell therapy is changing the future of leukemia, giving new hope to patients everywhere.

Advanced technology is used to separate white blood cells from the rest of the blood cells. These T-cells are then engineered in a specialized laboratory to produce specific chimeric antigen receptors (CARs) on their surface. Before returning the modified T-cells to the patient, they are multiplied in a lab until they number in the millions.  

Once the new CAR T-cells are injected into the patient’s bloodstream, they identify tumor cells and latch on to the coordinating antigens, killing the cancerous cells. In effect, they are programmed to hunt and kill the malignant cells.

Only one infusion of CAR T-cells can last for years, because the cells remain in the patient’s body – growing, dividing, and continuing to attack the tumor.

Leading Doctors Specialized in the Treament of Acute Lymphoblastic Leukemia

Dr. Elad Jacoby, Attending Physician, Pediatric Hematology and Oncology Department, and

Investigator of Pediatric Cancer Immunotherapy at Sheba’s Edmond and Lily Safra Children’s Hospital founded the CAR-T program for ALL in Israel. After training extensively at the National Cancer Institute in the United States, he brought his unique, premier qualifications in CAR T-cell therapy to Israel.

Prof. Arnon Nagler, Director of the Division of Hematology, and Director of Bone Marrow transplantation and Cord Blood Bank at Sheba is a world-renowned expert in CAR-T therapy. He is one of three board members of the organizing committee of the largest European conference on CAR-T, held annually by the European Society for Blood and Marrow Transplantation and Cellular Therapy. In 2019, he was the keynote speaker for the conference. Prof. Nagler has also published extensively on the subject in numerous medical journals.

Types of ALL Treated with CAR-T Therapy in Israel

In acute lymphoblastic leukemia, abnormal cells block the production of other healthy blood cells, such as red blood cells and platelets. What’s different about ALL is that unlike other cancers, it does not usually form tumors. Instead, it affects the bone marrow of the entire body.

By the time ALL is diagnosed, it has often spread to multiple body organs. Therefore, it’s impossible to stage ALL in the same way as other cancers. Instead, it is categorized by the types of lymphocytes involved. The type of ALL that a person has will help doctors design the best treatment plan and predict its effectiveness.

According to the World Health Organization (WHO), acute lymphoblastic leukemia is divided into three subtypes:

• Precursor B lymphoblastic leukemia, more common and usually found in adults
• Precursor T cell ALL, less common and more likely to affect young adults and men
• Mature B cell ALL, identified by certain genetic changes

At Sheba, CAR-T therapy can be administered for several types of leukemia and lymphoma, including precursor B lymphoblastic leukemia.

Efficient, Fast & Convenient – The Benefits of CAR-T for Acute Lymphoblastic Leukemia in Israel
At Sheba, full CAR-T facilities are offered under one-roof. For the patient, that means all stages of the process – blood harvesting, genetic engineering of the cells, T-cell injections and patient observation – are performed conveniently and efficiently on-site. As a result, it takes only a total of about 10 days to process the CARs.

In contrast, other medical centers use commercial CARs, which prolongs the process considerably – taking weeks or even months. Using commercial CARs means that the lymphocytes must be shipped overseas to be engineered. Especially now, during the Covid-19 pandemic, this can be a complicated hurdle. Unfortunately, the patient’s condition is also left to deteriorate while waiting, which reduces the chances of adequate response to the CARs.