13 December, 2021
Pictured L-R: Dr Larry Bacon (Consultant Haematologist), Olga Crehan (Pharmacist), Dr Nicola Gardiner (Chief Medical Scientist, Cryobiology) and Liz Higgins (CAR- T Cell Transplant Coordinator)
In a first for Ireland, a patient of St James’s Hospital has received a cell therapy treatment for lymphoma. This is a significant development for blood cancer patients and is the first time Chimeric Antigen Receptor –T cell (CAR-T) therapy is being delivered in Ireland.
Up until now, any patient who could benefit from this potentially life-saving personalised therapy had to travel to the UK to receive the treatment. Cell therapies like CAR-T are highly complex and involve collecting a patient’s own T cells, which are then prepared for export in the hospital's on-site stem cell laboratory. These cells are then sent overseas to a CAR-T manufacturing facility where they are re-engineered to target cancer cells. After rigorous quality control checks, the modified T cells are then sent back to the hospital’s stem cell laboratory and pharmacy for qualification before reinfusion. Prior to reinfusion the patient receives three days of lymphodepleting chemotherapy.
Under the care of consultant haematologist Dr Larry Bacon and clinical nurse specialist, Liz Higgins, the first CAR-T patient received an infusion of his own CAR-T cells in the National Adult Allogeneic Bone Marrow Transplant unit (Denis Burkitt ward) which has over 30 years’ experience in bone marrow transplantation and has recently been designated Ireland’s National Adult CAR–T Cell Centre. St James’s Hospital has worked closely with the HSE’s National Cancer Control Programme (NCCP) and the Department of Health to deliver this cutting edge therapy to patients in Ireland for the first time.
This new therapy is currently licensed to treat specific blood cancers, including Acute Lymphoblastic Leukaemia (ALL) and Diffuse Large B-Cell Lymphoma (DLBCL), a subtype of non-Hodgkin lymphoma (NHL). However, it is expected that use of CAR-T cell therapies will grow exponentially and will include other diseases in coming years.
Minister for Health Stephen Donnelly TD welcomed today’s news, saying: “I welcome the commencement of a national CAR-T therapy service for cancer patients at St James's Hospital. This therapy had previously only been available overseas and it will make a huge difference to people to be able to access it in Ireland. I hope that CAR-T therapy will greatly improve treatment outcomes for many over the coming years. I provided €57 million this year for the development of cancer services, improvements in cancer screening and new cancer drugs. It is great to see the direct benefits that this funding is bringing to patients through new initiatives such as CAR-T therapy.”
Dr Larry Bacon, clinical lead for the National Adult CAR-T Centre at St James’s Hospital, said: “CAR-T therapy is a lifeline for suitable blood cancer patients whose other treatment options have been exhausted. It is the most advanced immunotherapy currently available for patients with lymphoma. CAR-T therapy marks a huge breakthrough in the treatment of relapsed and refractory disease in particular, and St James’s Hospital is very pleased to be able to treat these patients in Ireland for the first time. This programme has been made possible through a massive collaborative effort between the Haematology, Oncology and Palliative Care (HOPe) Directorate and medical, nursing, cryobiology laboratory, pharmacy and corporate teams, along with the Department of Health and the NCCP.”
While the treatment has around a 40% success rate, without it, most of these patients will face terminal illness. The HSE spent €8.18m on Irish patients receiving this therapy in the UK in 2019 and 2020, via the Treatment Abroad scheme.
The first patient, who wishes to remain anonymous, is from Co Mayo and was referred from University Hospital Galway. The patient said: “I’m thrilled to be able to access this treatment in Ireland. I feel like I was on the edge of a cliff about to fall off and I've been thrown a rope and I'm going to grab it with both hands. It has not been an easy road for me and my family, but now I feel like I have a fighting chance.”
Mary Day, CEO of St James’s Hospital, said: “With the Trinity St James’s Cancer Institute, the only OECI accredited cancer institute in the country, here at St James’s Hospital, we are proud to be leaders in the delivery of new and innovative cancer treatments for our patients. We look forward to delivering this very specialised and potentially curative therapy to more blood cancer patients from across the country and continuing to provide the highest standard of clinical care.”
In 2019, the American Society of Haematology described CAR-T therapy as “the next big thing” in blood cancers. CAR-T therapy is available in more than 15 EU countries, and has been publicly available in England through the NHS since 2018. The NCCP has designated St James’s Hospital as the initial National Adult CAR-T centre in Ireland and Children’s Health Ireland (CHI) in Crumlin as the National Paediatric CAR-T centre.
Professor Risteárd Ó Laoide, National Director, NCCP said: “The treatment today of the first patient in Ireland with CAR-T is most welcome and is the culmination of more than three years of collaborative work between ourselves, the Department of Health and St James’s Hospital. The NCCP continues to work towards improving patient outcomes by leading on the establishment of new and innovative services, such as CAR-T, in designated cancer centres.”