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CAR-T Leaves Myeloma Patients Vulnerable to Infection?

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Does CAR-T therapy leave myeloma patients vulnerable to infection? What about CAR-T therapy’s ability to “harness the immune system?” 

How can a therapy “harness the immune system” but leave the myeloma patient vulnerable to infection at the same time???

Even I would agree that CAR-T cell therapy has great potential for heavily pre-treated myeloma patients. The problem is, as of the writing of this post, CAR-T therapy brings with it several serious challenges such as:

  • Risk of serious side effects
  • Ridiculously expensive
  • too many patients relapse

At this stage of MM treatment, patients who have undergone 3,4 event 5 therapies may have little choice but to undergo CAR-T therapy to buy more time. These patients may be enrolled in a clinical trial and therefore not care much about the high cost of treatment. Lastly, these patients may not even care much about possible serious side effects.

When I was told about an experimental procedure that also had great potential in 1995, I signed on immediately. PeopleBeatingCancer’s tagline is “I wish I knew then what I know now.”


What types of infection can result from myeloma patients undergoing CAR-T cell therapy?

1. Bacterial Infections

  • Early-phase infections (within the first few weeks) often involve bacteria, partly due to chemotherapy used in the CAR-T preparation. The immune suppression can lead to bacterial pneumonia, bloodstream infections, and urinary tract infections.
  • Later bacterial infections can also occur as the immune system remains compromised due to long-term effects on normal B cells and immunoglobulin levels.

2. Viral Infections

  • Reactivation of latent viruses is common, including herpes simplex virus (HSV), varicella-zoster virus (VZV), and cytomegalovirus (CMV).
  • Respiratory viruses, such as respiratory syncytial virus (RSV) and influenza, are also significant risks, especially during the first year following CAR-T therapy.

3. Fungal Infections

  • Aspergillosis and other fungal infections can occur, particularly if patients have prolonged neutropenia (low neutrophil count) or have received steroids or other immunosuppressive drugs.
  • Opportunistic fungal infections, such as Candida, may also arise, especially with central line use or mucositis from the therapy.

4. Opportunistic Infections

  • CAR-T therapy leaves patients at higher risk for opportunistic pathogens like Pneumocystis jirovecii and Nocardia species.
  • Parasitic infections can also arise, although they are less common and depend on patient demographics and exposure risks.


CAR-T therapy for RR/MM patients offers hope to RR myeloma patients. So why am I knocking CAR-T therapy?

Non-conventional therapies have helped me immensely since I reached complete remission in 1999. Unfortunately, conventional oncology does not study, research or promote any type of non-conventional therapy that I know of.

Could there be non-conventional therapies show to boost the patients immune system that conventional oncology doesn’t know about? 

Email me with your ideas for immune boosting therapies- David.PeopleBeatingCancer@gmail.com

Thanks,

David Emerson

  • MM Survivor
  • MM Cancer Coach
  • Director PeopleBeatingCancer

Does CAR T-cell therapy leave patients vulnerable to infection?

“When they work, engineered immune cells called CAR T cells can beat back even advanced leukemias and lymphomas. (and multiple myeloma)

But there is a catch. The proteins they sniff out on cancerous cells can also appear on healthy B cells, which make infection-fighting antibodies. The CAR T cells can’t distinguish between friend and foe, so they destroy both.

That collateral damage may leave patients vulnerable to infection. No B cells means no protective antibodies — tiny Y-shaped proteins that neutralize bacteria and viruses.

The long-term effects of CAR T-cell therapy on this key part of the immune system are poorly understood, said Dr. Joshua Hill, an infectious diseases specialist at Fred Hutchinson Cancer Research Center. And no data exist to guide efforts at preventing infections in these high-risk patients.

Hill plans to change that. He will use a new five-year, $3.3 million grant from the National Cancer Institute’s Cancer Moonshot program to study the holes this immunotherapy leaves in patients’ defenses against infection — and how doctors can fill them. Hill will lead an interdisciplinary team of researchers from Fred Hutch and Seattle Children’s focused on CAR T-cell therapies used to treat blood cancers.

As the number of patients treated with CAR T cells grows, the work will address critical knowledge gaps in how best to provide long-term care, Hill said.

“(CAR T-cell therapy) is a new frontier with unique infection risks because we’re knocking out B cells,” he said. “The goal of this work is to understand what exactly is happening to the immune system and what are the most cost-effective and patient-friendly ways of dealing with it.”

Diverse Immune Effects of Bovine Colostrum and Benefits in Human Health and Disease

Colostrum for Immune-Nutrition in Elderly Subjects

Aging is associated with decreased immune responses, including the T lymphocyte immune response. This impairment may predispose aging population to infections, cancers and autoimmune diseases [].

In a study on elderly, sedentary, non-smoking patients who met the inclusion criteria for immunogerontological studies and had low natural killer (NK) cell activity, a symbiotic mixture of Saccharomyces boulardii lysate in cranberry, colostrum-derived lactoferrin (which is bio-active for microbes),

Fragaria, and lactose was administered twice daily for 2 months and compared with an identically tasting fruit juice placebo. A significant enhancement in NK cell activity of symbiotic mixture consumers was observed as compared to a placebo at the end of 2 months [].

Of course, it is difficult to ascertain to what extent colostrum-derived lactoferrin was responsible for the effect on NK cell activity and whether this influenced protection against infections…

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