The Ride of Her Life

Sandra Davis-Quinney has met bumps, curves and stops on her cancer journey. Even with the rough roads she’s traveled, Sandra tries to remain hopeful, resiliently staying on the ride.

Her determination brought her to UF Health Cancer Center’s Jack Hsu, M.D. After multiple rounds of chemotherapy from 2017 to 2019 were unsuccessful against her non-Hodgkin’s lymphoma, Sandra’s next option was a stem cell transplant. However, when her physicians were unable to collect enough stem cells for a transplant, that option was taken off the table. Heading home to Jacksonville to get back on medication and let her body “get itself together,” Sandra met with her UF Health Jacksonville oncologist, Joseph Mignone, M.D., and began looking into other available options.

When she learned at UF Health about the novel chimeric antigen receptor (CAR) T-cell therapy, a genetic therapy that modifies the patient’s own cells to attack their cancer, she knew her ride was just finally gaining momentum. Sandra was a candidate for the treatment, but she wasn’t just any candidate — she was the first CAR T-cell patient at UF Health.

Hsu and his UF Health Bone Marrow Transplant Unit team spent two years preparing to become certified as a CAR T-cell therapy site — developing policies and procedures, building relationships with those in other subspecialties and earning an accreditation for a stem cell lab. In October 2018, UF Health became a designated site for administering the therapy.

“This is the first genetic therapy that was approved for the treatment of adult hematologic malignancies,” said Hsu, a clinical associate professor of medicine in the UF College of Medicine. “It provides another option for patients who have very-high-risk lymphoma.”

The reality of being the first CAR T-cell patient at UF Health didn’t sink in for Sandra until the process was set in motion, she said. She had heard about different clinical trials and new treatments, but now she was the star of the show in one of them.

“Being the first patient is a big deal,” she said. “If it affords other people the opportunity and the availability is here for them, then that’s great.”

The initial extraction of her cells wasn’t what she expected. She imagined it would be invasive and painful, but the procedure ended up being more like drawing blood.

“You feel different in your body because they extract the blood, extract what they need from the blood, and put it back into your body,” Sandra said. “I was freezing cold, but it wasn't painful.”

Going through the actual CAR T-cell therapy was a different story. Because she had been through multiple rounds of chemo, Sandra said the therapy itself was bearable.

“It was not pleasant at times, but it wasn't really bad until I went through the process of where I had to go to the intensive care unit,” she said.

There are two possible major side effects to the treatment — cytokine release syndrome, which causes patients to develop swelling and their blood pressures to drop; and neurotoxicity, which causes changes to patients’ mental status, Hsu said. Sandra developed both.

“Getting her through that, since we didn’t have practical experience before this, was very exciting because although we knew what to expect, actually seeing it was a different experience,” Hsu said.

Because she developed neurotoxicity, Sandra doesn’t remember the week she spent in the intensive care unit. For days, she was coherent and talking, but there’s a gap where the memories of those days should be.

Although her body is still adjusting to life after CAR T-cell therapy, an evaluation three months after her therapy revealed the news Hsu, Sandra and her family longed to hear — her lymphoma is in complete remission.

“No pain, no gain,” Sandra said. “I just do what I need to do and live life as a happy day every day.”

Hsu said treating the first CAR T-cell patient at UF Health was scary yet exciting. He was confident in the policies and procedures he and his team spent years perfecting.

“I'm happy to say that because we spent some time ironing out the details and trying to figure out potential points of failure, we didn't really have much of a problem,” he said.

The CAR T-cell therapy program at UF Health opens doors to new opportunities for patients, physicians and researchers. Now, UF Health can participate in CAR T-cell-specific trials and work with pharmaceutical companies to target other diseases.

“Developing this program gives us the ability to participate in trials of this class of therapy because not all facilities are going to be able to do this,” Hsu said.

CAR T-cell therapy is in active investigation, not only for other blood cancers like multiple myeloma but also solid tumors like colon cancer. These treatments will become an important therapeutic option for patients like Sandra, especially as similar therapies are further designed and explored.

The accessibility to novel treatments like CAR T-cell therapy is why Sandra says she chose UF Health. While her cancer journey hasn’t always been smooth, her determination to stay on the ride has led her to the finish line.

“There are challenges. There's days that I’m disappointed with what my counts are, but I don't let it discourage me,” she said. “I keep praying, driving, putting fuel in my tank and propelling forward.”