Aline Luiz Oliveira, 25, was diagnosed with B-cell acute lymphoblastic leukemia in 2019. Born in São Lourenço (MG), the Accounting Sciences student has always faced her treatment with optimism. Despite the challenges, she says that she wanted to “sail through” and that her goal was to get out of that situation as soon as possible. But even after nine months of chemotherapy, followed by several side effects, and a bone marrow transplant with a 100% compatible donor, the cancer resisted and returned in 2021. The feeling was one of defeat, but Aline found a new hope with CAR-T cell therapy – which used her own defense cells to fight the disease.
The student received the infusion of CAR-T cells in February of this year. The severe pain in her legs due to leukemia, which often prevented her from even walking, disappeared in a matter of 24 hours. She was discharged from the hospital after 15 days. “After a week, we already saw excellent results. The exams started to show that everything was going well, it was fantastic,” he says. At first, she had weekly medical follow-up, then fortnightly, and now once a month. Feedback remains positive.
Aline returned to her normal life and is now able to practice physical exercises, one of her favorite hobbies. Recovered, she remembers the disappointment in which she found herself after the disease relapsed. “When you undergo all the treatments available and you have a post-transplant relapse, you think that life has no meaning anymore, that you ran out of options. But then came CAR-T. At first I didn't believe it much, but as I did my research, I saw that in other countries it was already a super advanced, top-notch treatment, and it got me excited.”
Aline's treatment was carried out at the Hospital das Clínicas of Ribeirão Preto Medical School, University of São Paulo (FMRP-USP), under the responsibility of hematologist Renato Cunha and his team. CAR-T therapy has been developed and applied experimentally in Brazil for three years, at the Regional Blood Center of Ribeirão Preto, in patients who did not respond to conventional treatments. After the bone marrow transplant failed, there was the possibility of a new transplant, but this time with Aline's mother as a donor, which had a compatibility of only 50%. That's when doctors opted for CAR-T.
According to the student, in addition to being innovative, cell therapy is more practical, faster and less painful. Her only adverse reaction was fever, which was soon reduced. It is common for CAR-T cells to induce a “cytokine storm” in the body, that is, an intense inflammatory response. During chemotherapy, Aline felt fatigue, dizziness, shortness of breath and nausea, in addition to hair loss. The aftercare was also quite different than her previous experiences.
“I left the hospital much stronger than when I had the transplant. After the transplant, I was very weak, anemic. But with CAR-T, I left full of life. It's totally different, there's no comparison.”
Sense of freedom
After her diagnosis, Aline had to take a break: from college, work, the gym; she also stopped traveling, something she is very fond of doing. Gradually, after receiving cell therapy, she resumed her activities. After two years without seeing the sea, she went to the beach. “I felt free, like I had my freedom back. From the moment you have restrictions, you feel trapped. And then when you get to carry on with your life, it feels really nice.”
Aline has many plans for the future, such as professional fulfillment and becoming a home owner, but she says her greatest wish for now is peace of mind. She has always enjoyed going to mass every week and believes that faith is a powerful tool. “I became completely hopeless, but I still joined God and had faith. And it all worked out. Things work out when you don’t stop believing. Our mind rules the rest.”
Access to CAR-T in Brazil
In CAR-T cell therapy, the patient's blood is collected and the cells of interest are isolated in the lab – in this case, the T lymphocytes of the immune system. These cells are genetically modified to become CAR-T cells. These are able to recognize tumor cells and destroy them. The CAR-Ts are then infused back into the patient in a process similar to a blood transfusion.
In June, Instituto Butantan, USP and the Regional Blood Center of Ribeirão Preto inaugurated two CAR-T production units, in a partnership that will help expand access to treatment and make it available in the Unified Health System (SUS) in the future. Located in São Paulo and Ribeirão Preto, the Advanced Therapy Centers (Nutera) will have the capacity to treat 200 to 300 patients per year – as of today, application of this therapy is experimental and on a small scale.
Aline participated in the inauguration of the Nutera-SP facilities on June 14 and believes that many other patients will be able to access and benefit from advanced therapy.
“I've been undergoing treatment since 2019 and I've met many people who have passed away and didn't have the same opportunity I had. For all of them, and for the others to come, it's great to know that everyone will have access to it."