New treatment for the painful side effects of blood cancer


The use of BK virus (BKV) specific T cells from healthy donors to treat BKV-associated hemorrhagic cystitis, a painful side effect associated with immunosuppression of stem cell transplants, may relieve the complication more quickly in patients. with lymphoma or leukemia, depending on the results of the trial.

“What was very important was that within a week after the administration of the cells, the majority of the patients’ symptoms improved,” said Dr Katy Rezvani, professor of stem cell transplantation and therapy. cell phone at the University of Texas MD Anderson Cancer Center in Houston and lead author of the study, said in an interview with CURE®. “The effect of the cells is relatively quick.”

BKV-associated hemorrhagic cystitis occurs more frequently in patients with leukemia or lymphoma who have received allogeneic stem cell transplant therapy. As a result, this can lead to patients having blood in their urine and passing clots, which can cause urinary retention (difficulty urinating or completely emptying the bladder) and, in more severe cases, kidney disease. .

In patients who receive stem cell transplants, those who have a half-match (when patients have only a few genetic similarities to the donor’s immune system) are at an increased risk of BKV-associated hemorrhagic cystitis because they are more immunocompromised. About 40% of patients who have a half-game develop this complication.

In the phase 2 trial, BKV-specific T cells, which recognize and attack BKV, from healthy donors were administered once intravenously, with the option of receiving additional doses every two weeks if necessary. Of the 59 patients included in the trial, 67.7% had complete (all symptoms resolved) or partial (almost all symptoms resolved) responses within 14 days. This rate rose to 81.6% after 28 days.

Some intolerance has been observed in patients who have been previously treated with steroids, which can kill T cells. There have been no side effects, and there have been no reports of new liver disease or disease. graft versus host (GVHD, which occurs when donor cells attack patient cells) associated with antiviral T cells, with the exception of a few cases of cutaneous GVHD. this resolved quickly with corticosteroids.

This treatment has the potential to stop the vicious cycle that accompanies the current standard of care, which consists of hospitalization with continuous irrigation of the bladder (using a catheter to wash the bladder) and an infusion of morphine for help patients tolerate pain, according to Rezvani. .

“This outpatient treatment saves patients from having to be admitted (to the hospital), which is wonderful because patients come to the hospital with one thing, they stay in the hospital for a few weeks, and then they develop. other complications, ”Rezvani explained. “They start to get other infections, they get pneumonia, they are malnourished, etc.”

According to Rezvani, a donor can produce up to 50 doses of T cells, which are frozen until needed. “Every time the patient comes (to the hospital), within 24 hours, we can treat them,” she said.

It is worth noting that the therapy is only available to MD Anderson, so patients with the complication should come to the health center to receive it – an option that may not be possible due to their physical condition. or their finances. “Hopefully we will get to a situation where we can start a multicentre study at some point,” said Rezvani, which would make care more accessible to patients. “In the meantime, I think the biggest limitation is really that patients will have to come to MD Anderson to receive the treatment, and for many patients with the terrible BKV hemorrhagic cystitis, that is obviously not possible.”

Until then, Rezvani is focusing on the next generation of treatment: genetically modifying BKV-specific T cells that are more resistant to steroids, thus broadening the spectrum of patients that treatment might help.

“It is important to realize that the use of immunotherapy against viruses and cancers (has) opened a very exciting new era of treatment for our patients,” she concluded. “We’re learning a lot more about the immune system (and harnessing) the power of the immune system to fight infections and cancer. … I think the field will continue to grow, and many other such treatments to target both viruses and cancers (will) be available. “

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