Dr. David Maloney kindly allowed Brian to interview him on 3/15/2018 in Seattle… but more on that later.
As Brian’s wife and caregiver, on the eve of his infusion with his own CAR-T cells, I write to you the following:
I am a musician, not a medical person. None of my family in knowable history have practiced the art of medicine. However, in my household growing up, the name of William Harvey (famous, among other things, for his discovery of the circulation of the blood, which revolutionized the practice of medicine) was venerated and spoken in a reverential tone as far back as can be remembered, because tentacles of my mother’s lineage have long borne the name… and generations of my family have not been allowed to forget that the fruit of his dogged investigations opened a universe to modern medicine… though there is no DNA evidence to prove our relationship.
As a child, I obsessed about what it would be like to walk alongside such a person.
Since March 6, Brian’s T-cells have been undergoing a profound transformation. Each manufactured batch of CAR-T cells is a bespoke living drug, specifically tailored to and from one individual to fight their own cancer, and it is this that we are waiting for. It is with meticulous care, similar to that of a master tailor, that the scientific and technical teams are creating this unique, potentially life-saving product.
His cells are scheduled for delivery March 22 at 1:00 p.m., but that timeline may not be met, as multiple checks and balances are built in on the morning of the re-infusion, including the required approval of the FDA.
As this is a clinical trial, the medical team will launch into dogged investigation and documentation of things unknown about his CAR-T cells at every level:
- Are they alive?
- Are they free from infection?
- Are there enough of them?
- Are there too many of them?
- Are the CD4/CD8 ratios correct?
- Will the cells be effective… and a dozen other questions that we have not even thought of.
I will await the effects and outcome of Brian’s immunotherapy with the nervousness of a parent:
- What do I need to look out for?
- How sick will he be?
- How abruptly can his state of health change?
- Will he have long-term neurotoxicity?
- Will he ever be completely free of CLL?
- And what will they learn about his unique microenvironment?
In the midst of worrying over these unanswered questions, I began to cheer up realizing that, while William Harvey’s most famous discoveries generally established principles that apply to all of us as living beings, what Dr. Maloney and his team here are doing seeks to harness a thing that is unique about each one of us, then to use it to cure blood cancers, including CLL (chronic lymphocytic leukemia).
Will this thrust modern medicine into a new universe?
Will there be a time when all drugs for cancer are living drugs?
As we travel this CAR-T path, searching for a cure for CLL (chronic lymphocytic leukemia), we may well be following the lead of a new generation of William Harveys.
Please listen to Dr. Maloney’s interview and think good thoughts. You can access the transcript here.