When 25-year-old Accounting Sciences student Aline Luiz Oliveira received the infusion of CAR-T cells, she didn't think it would work. After nine months of chemotherapy, the treatment with the genetically modified cells did not cause hair loss, nor nausea, let alone suffering. A few weeks later, the surprise: the debilitating pains in her legs, which were the main symptom of type B acute lymphoblastic leukemia, simply disappeared. “When my pain was gone, when I knew that CAR-T cells were taking over my body, I got excited”, she recalls. Aline still cannot be considered cured of cancer – for medicine, this only happens after 15 years of remission – but, in practice, that is exactly what happened.
She is one of seven people who have already been treated in Brazil with CAR-T (Chimeric Antigen Receptor) cells, an advanced cell and gene therapy used to fight blood cancers such as lymphoma and acute lymphoblastic leukemia. And it was precisely with this experience that she took part, on the morning of this Monday (14), in the launch of the largest program of CAR-T cell therapy against cancer in Latin America, carried out by the government of São Paulo and the result of a partnership between Butantan, the School of Medicine of the University of São Paulo (FMUSP), the School of Medicine of Ribeirão Preto (FMRP-USP) and the Ribeirão Preto Blood Center.
Through the program, two cell therapy production units were built: the Advanced Cell Therapy Center (Nucel), at the “Cidade Universitária” (USP’s campus) in São Paulo (SP), and the Advanced Therapy Center (Nutera), located in Ribeirão Preto (SP). Together, the facilities will be capable of treating 200 to 300 patients per year – currently, this therapy is experimental and on a small scale.
The CAR-T technology is a type of immunotherapy that uses T lymphocytes, cells of the immune system responsible for fighting pathogens and killing infected cells. The T lymphocytes are removed from the organism, isolated and activated - i.e., “reprogrammed” to be able to identify cancer cells. Then, they are infused back into the pacient’s organism. The modified defense cells come back stronger to eliminate the tumor cells. This entire process, from cell collection, modification and administration to the patient, can last around 60 days.
Aline was infused with CAR-T cells in February 2021 after receiving a diagnosis of remission after undergoing a bone marrow transplant. “It is a big step forward. I've been doing treatment since 2019. I met many people who passed away and didn't have the same opportunity I had. For all these people, and for the ones who are coming, it's great to know that everyone will have access to it,” vibrates Aline. Aline's treatment was performed at the Hospital das Clínicas in Ribeirão Preto, under the responsibility of physician Renato Cunha and his team.
According to the president of Instituto Butantan, Dimas Covas, the hematologist who led the studies on CAR-T cells in Ribeirão Preto, this cell therapy is the most modern and advanced there is among the current cancer treatments. “We are talking about the possibility of curing, with low toxicity, some of these diseases. This is the treatment of tomorrow,” he states. “It is a highly innovative therapy.”
The main differential of the cell therapy program is that it will allow, in the medium term, taking the most advanced resource in the world against cancer to Brazilian patients through the Unified Health System – the main goal of the partnership between Butantan, USP and the Blood Center. To do so, a clinical trial will be carried out later this year, involving 30 B-cell non-Hodgkin lymphoma patients. According to Dimas Covas, the development and infusion of CAR-T cells can cost around US$ 1 million per patient outside Brazil – US$400,000 for the therapy itself, plus US$500,000 for hospital expenses.
A little over a year after the cells were infused, Aline is still in remission, and is followed up monthly in Ribeirão Preto. She cites “practicality” as a great advantage of cell therapy. “Besides being a revolutionary treatment, it is much more practical, because you have a much shorter hospital stay and you get much better.” When leaving hospital after the transplant, Aline was weakened and anemic. After her CAR-T treatment, it was a completely different scenario: “I was full of life.”