Portal do Butantan

From the hospital to the volleyball court: medical student treated with CAR-T achieves leukemia remission after four relapses


Publicado em: 01/01/1970

Winning the college championship volleyball game, one of his passions, and being named player of the match: that's how Lucas Visconti, 27, celebrated the success of his new treatment with CAR-T cell therapy a few days after being discharged from the Hospital das Clínicas of the University of São Paulo (HC-FMUSP). The medical student from Paraíba do Sul (RJ) was diagnosed with B-cell acute lymphoblastic leukemia in 2017, aged 22, and even with several chemotherapy sessions and a bone marrow transplant, the cancer returned four times. With the number of relapses and the absence of a new compatible donor, he was one of the first Brazilian patients with leukemia to be indicated for experimental therapy with CAR-T cells, developed at the Advanced Cell Therapy Center of the Regional Blood Center of Ribeirão Preto (SP).

CAR-T cell therapy is an innovative treatment that uses the patient's own defense cells, genetically reprogrammed in the lab, to fight cancer cells. However, its access is extremely limited, as it is only approved outside the country and can cost US$ 500,000 per application, reaching US$ 1 million with hospital expenses. In Brazil, the therapy has been used in recent years by medical decision in patients who have already exhausted all treatment options and have not improved – as was the case of Lucas, elected for therapy earlier this year.


According to him, he used to have a lot of headaches, sometimes even fainting. After trying several neurologists, none gave him a diagnosis. Then the headache developed into double vision (diplopia). After consulting with an ophthalmologist, he was treated with corticosteroids and improved, but as the medication was withdrawn, the symptoms returned. Lucas and his family continued to look for answers until, during a trip with friends, he fell ill and was taken to the hospital. The neurosurgeon that assisted him performed a lumbar puncture to access the cerebrospinal fluid (liquid that permeates the brain and spinal cord, in the lumbar region) and discovered intracranial hypertension, indicating the need for surgery.

Lucas was hospitalized, but, during his preop, he took steroids again and the symptoms improved again. After analyzing the cerebrospinal fluid, the doctors found that his condition was not neurological. Surgery was canceled and he was referred to a hematologist.

“When I received the diagnosis of leukemia, in 2017, it was like a movie scene when the person is knocked out and looses sense of their surroundings. The hematologist explained everything, but at that moment I could no longer pay attention.”



Persistence

Lucas dropped out of college, underwent six months of chemotherapy and responded very well to the treatment. However, in 2019, he first received the news that the disease had returned. He then traveled to São Paulo and began seeing hematologist Vanderson Rocha, director of the Bone Marrow Transplantation unit at HC-FMUSP. The student received his brother's bone marrow transplant, which was a 50% match, and once again reached remission.

A year later, in 2020, Lucas suffered another relapse. At that time, his doctor recommended treatment with CAR-T cells, but it would have to be done abroad and it was very expensive. The other option was to have a more aggressive chemotherapy. “It was very hard, but despite the expected side effects, everything went well”, says the student, who handled the situation well, despite the difficulties. The treatment was successful and Lucas was considered cancer free.

But in early 2021, the cancer reappeared for the third time, requiring new chemotherapy sessions. At the end of the year, came the fourth recurrence. “I always had all the support, everything always went in the best way, but it's never easy. You think everything is fine, you start to move on and the disease returns. It's hard to stop and readapt my life all over again, to get away from everything I love doing, from sports, from college.”



A game (and life) changer

Despite the disappointment of a new recurrence, there was also good news: Lucas was selected to participate in the experimental therapy with CAR-T cells at the Cell Therapy Center in Ribeirão Preto. “He underwent several treatments, and we know that relapsing, even after a transplant, is a very serious case. After taking a closer look at the case, we decided that the ideal solution would be CAR-T. So this opportunity arose with the team from Ribeirão Preto. Without them, we could not have done the treatment. Lucas' story is not just his story, but that of several Brazilians who need cell therapy,” says physician Vanderson Rocha.

Lucas was hospitalized on Feb. 21 and, while preparing to receive the therapy, he tested positive for Covid-19 and had to wait another two months to start treatment. During that period, one thought kept coming up: how badly he wanted to play volleyball in the college championship. “Even in the hospital, I exercised as much as I could and tried to stay active as much as possible. It's my last year of graduation and playing in this championship meant a lot to me."

On April 26 he received the CAR-T cells and his organism responded very quickly: his T lymphocytes, now modified, were fighting the cancer. Lucas was under observation to monitor the adverse effects of the therapy, such as fever and headache, which in his case were mild and transient. The student had weekly follow-ups and now takes the exams every 15 days in São Paulo. He is in remission – he still cannot be considered cured, since for CAR-T cell therapy this only occurs after 15 years without the disease, but he is certainly victorious.

Lucas was discharged on May 21 and returned to his city just in time to participate in the college championship, which would take place in Valença (RJ), the city where he takes his courses. It was a Saturday, semifinals, tiebreaker, and his team was losing 6-0. He was on the bench and then the coach asked him if he wanted to play.


“I came in, we reversed the score and won. And I was also chosen as the best player of the match. It was a very special, very emotional moment – not only for me, but for everyone there who knew my story.”


Few limitations

For Lucas, the quick recovery and the low amount of side effects and restrictions were other advantages of treatment with CAR-T therapy. He didn't feel sick, tired, he didn't lose his appetite and he didn't even have hair loss. The student explains that chemotherapy and bone marrow transplantation are very physically debilitating treatments, and come with many restrictions, as they reduce immunity.

“I had a very low immunity. With the chemo, I got very tired and nauseous. CAR-T therapy was much more peaceful; all I had was a little fever. There is no comparison.”


The therapy of the future

The medical student shares his trajectory confidently and with many plans for the future. One of them is to become a hematologist so that he can help other people like him – mirroring the medical team that followed him during his battle.

“Now I can be a reference for future patients. I'm very happy and hopeful, I’m a strong believer that this is it. Everything will be fine, I will be able to graduate, work.”

An individualized and innovative treatment is getting closer to the reality of Brazilians. This month, Butantan, the University of São Paulo and the Regional Blood Center of Ribeirão Preto inaugurated two advanced centers for the production of cell therapy for cancer, one in São Paulo and the other in Ribeirão Preto. At first, the units will be focused on the treatment of blood cancers and will have the capacity to treat up to 300 patients per year. To be approved by the Brazilian Health Regulatory Agency (Anvisa), the therapy will still undergo clinical studies. Phase 1 should start in October, with 30 patients with B-cell non-Hodgkin lymphoma.

According to the president of Instituto Butantan, Dimas Covas, who is leading the study, this is a revolutionary technology. “Advanced therapies like CAR-T are the latest development in the biotechnology industry in the world. And we had the pleasure and satisfaction of launching the largest program for the production of this therapy in Latin America – and one of the largest in the world. This is absolutely innovative and unheard of in Brazil”, he says.


Hematologist Vanderson Rocha, who treated Lucas, believes that the partnership between the institutions is an important step towards changing the scenario of cancer treatment in the country. “This new center is a huge advance for Brazil and for all of Latin America, as the CAR-T cells will be produced in our own factory, without depending on the pharmaceutical industry. It is an opportunity for patients who cannot afford treatment outside the country. And this could open the door to other types of advanced therapies, such as gene therapies for genetic diseases,” he says.

For Lucas, seeing the positive results of CAR-T therapy not only in his personal experience, but in other researches in Brazil and in the world, is a great motivation.

“I am very happy not only for myself, but for all the other patients who will be able to undergo this treatment. It will definitely help a lot of people.”

 

Volleyball game photo credits: Aquarela Fotografia