As a retired nurse and a mother, Verna Seitz, 65, was used to caring for others. Life changed a lot when she was diagnosed with an aggressive blood cancer in 2019. Multiple myeloma affects the white blood cells in the bone marrow. With multiple myeloma, the white blood cells stop making antibodies to protect the person from infection — instead they become cancerous and crowd out the other healthy blood cells, leading to fatigue, weakness and frequent infections.
“My family and I decided we would do whatever it takes to get me healthy, and we weren’t giving up,” Verna said. “It was hard for me, but I let myself be taken care of and listened to what my body needed.”
Multiple Myeloma Diagnosis
For several years leading up to her multiple myeloma diagnosis, Verna’s bloodwork showed concerning levels of an antibody called immunoglobulin A (igA). She was being followed by oncologists in the Froedtert & the Medical College of Wisconsin Leukemia, Lymphoma and Myeloma Program and would get regular lab work to keep track of her blood counts. Ultimately, when her igA levels spiked in April of 2019, Verna had a bone marrow biopsy that confirmed multiple myeloma.
“That moment was a kick in the gut for me,” Verna said. “This is not just something that happens to someone else, this was happening to me. But I had confidence in my doctors, and I remember thinking to myself, ‘we’re going to get through this.’”
Multiple Myeloma Treatments
Multiple myeloma can be treatable, but it is almost impossible to cure. Verna was ready for whatever treatment her doctors recommended to give her the best chance of a lasting remission. She was young to be diagnosed with this type of cancer and was otherwise healthy. She enrolled in a clinical trial that allowed her to be treated with very strong immunotherapy drugs (a type of cancer treatment that helps a person’s own immune system fight cancer) that were usually reserved for people whose cancer had stopped responding to treatment. She tolerated the medication well. Verna also received chemotherapy and an autologous stem cell transplant, where her own healthy blood cells were collected and infused back into her bloodstream to help her bone marrow produce more new, healthy cells.
“I responded well to the treatments, and I thought we had beat it,” Verna said. “But, my myeloma was aggressive, and I relapsed in less than two years.”
In 2021, Verna needed another stem cell transplant; this time, her sister was the donor. Despite the transplant, Verna’s cancer remained aggressive and led to a complication called extramedullary plasmactyomas, which are cancerous plasma cell tumors that attack soft tissue (rather than bone.) She was treated with chemotherapy to the tumor. At that point, Marcelo Pasquini, MD, medical oncologist and MCW faculty member, recommended Verna for chimeric antigen receptor (CAR) T-cell immunotherapy.
“Patients usually have many treatment options for multiple myeloma,” Dr. Pasquini said. “But, Verna’s disease was very aggressive from the beginning, and it didn’t sufficiently respond to what we tried. CAR T-cell therapy would genetically re-engineer her T cells, and we would reinfuse them into her bloodstream to supercharge an immune response against the cancer cells.”
CAR T-Cell Therapy for Multiple Myeloma
CAR T-cell therapy is FDA-approved for some patients with certain types of blood cancers who are later on in their disease process. Most patients stay in the hospital for monitoring for at least seven days after treatment because early intervention for life-threatening reactions, such as cytokine release syndrome or neurotoxicity, is vital. All patients need to be closely monitored for the first 28 days after treatment. In unique cases, the treatment can be done on an outpatient basis instead of requiring a hospital stay, and Verna met all the criteria.
“Being able to be home and supported by a dedicated caregiver can be much more comfortable for the patient,” Dr. Pasquini said. “The challenge with outpatient CAR T-cell therapy is these patients can get very sick very fast, so we have appropriate support and monitoring mechanisms in place.”
For CAR T-cell therapy, T cells are collected from the patient — in a way that is similar to how blood is collected during a blood donation. Then, the T cells are separated and genetically engineered to express a new protein in their membrane, which helps guide their attack against cancer cell targets. The collected cells can be engineered at the CAR T lab on the Froedtert Hospital campus or at an external lab. After the product has gone through quality control assessments, patients receive a short chemotherapy course to prevent their body from rejecting the treatment. After the chemotherapy, patients receive their personalized CAR T-cell therapy via IV infusion in a single dose.
“CAR T-cell therapy is effective because it redirects the immune system toward a very specific target,” Dr. Pasquini said. “The re-engineered cells continue to multiply once they are infused, so their effectiveness increases. This is why we call CAR T-cell therapy a living drug; it expands to target the quantity of cancerous cells the patient has. An antibody against the same target does not have the same intensity or effect as CAR T cells.”
The CAR T process is mostly the same for inpatients and outpatients. The difference is that outpatients like Verna go home after the infusion and come back to the hospital daily for follow-up appointments.
“My husband was my primary caregiver, and we monitored my temperature frequently in case I developed a fever,” Verna said. “I tolerated the treatment very well and avoided complications. You need to be in tune with your body and have a strong support system to be an outpatient for this, but I’m so grateful I was given the opportunity to receive outpatient CAR T and return home each day. That made all the difference for my comfort and positivity.”
Multiple Myeloma Remission with CAR T-Cell Therapy
It is not possible to cure multiple myeloma because of how easily each person’s individual disease can change and adapt to different treatments. The goal for Verna was to put her multiple myeloma in remission with CAR T-cell therapy. To determine if treatment was a success, Verna had another bone marrow biopsy and a PET scan. The scan was clear and the biopsy showed no cancerous cells. Dr. Pasquini is optimistic that Verna’s myeloma will stay in remission, but treating multiple myeloma with CAR T-cell therapy is still relatively new, and there isn’t enough data to know what to expect long-term.
Verna gets monthly immunoglobulin infusions, or antibody infusions, to help bolster her body’s ability to fight off potential infections, but she is slowly getting back to feeling like her old self. She enjoys long walks with her husband and recently reached the milestone of riding her bicycle. She also supports friends who have been diagnosed with cancer by sharing her experience, offering encouragement and answering their questions.
“A cancer diagnosis and its complex treatment plan can be very overwhelming; however, I continued to ask questions to better understand my myeloma and our plan to treat it, which reduced my anxiety,” Verna said. “I hope sharing my story will help someone. There is no such thing as certainty, but trusting your doctors and care team and being an active partner in your care reduces your vulnerability. They were never at a loss for options, and that instilled so much confidence in me throughout all of this. It hasn’t been easy, but I will soon have six grandchildren, and I have a lot to live for. I won’t give up.”
Learn more about CAR T-cell therapy and other immunotherapy cancer treatments.
