Treatment of acute myeloid leukemia (AML) with CAR T-cell therapy (program ID: 666037)
University Hospital Muenster
Georg LenzSpecialized in: hematology, hemostaseology, oncology, pulmonology
Department of Hematology, Hemostaseology, Oncology and Pulmonology
- Initial presentation in the clinic
- Clinical history taking
- Physical examination
- Review of medical records
- Laboratory tests:
- Complete blood count
- General urine analysis
- Biochemical blood test (kidney and liver function tests)
- Indicators of inflammation (CRP, ESR)
- Indicators of blood coagulation
- Immunohistochemical and genetic analysis of tumor cells (if indicated)
- Leukapheresis, processing of T-cells and cultivation of CAR T-cells
- Adjuvant chemotherapy
- Infusion of modified CAR T-cells to a patient
- Control examinations
- Cost of essential medicines and materials
- Nursing services
- Full hospital accommodation
- Explanation of future recommendations
- Acute myeloid leukemia (AML) that is resistant to the conventional therapy
How program is carried out
Days 1-2. Initial presentation at the clinic. The doctor collects the patient's medical history, looks at his medical records and previous examinations. Special attention is paid to previous cancer treatments and their results, since CAR T-cell therapy is indicated only if the conventional treatment protocols are ineffective. Based on the results of the consultation, the doctor administers the examination, which includes a complete blood count with white blood cell count, assessment of liver and kidney function, immunohistochemical and genetic analysis of tumor cells (if indicated) and other studies.
Day 3. Collecting patient’s blood. During the leukapheresis procedure, doctors harvest at least 100 million T-cells, which will subsequently undergo gene modification. If there are certain clinical reasons, and the patient needs to postpone the subsequent stages of CAR T-cell therapy, the harvested T-cells undergo the procedure of cryoconservation. If the patient is able to continue treatment immediately, then the harvested T-cells are transferred to the laboratory.
Days 4-12. Processing and gene modification of the T-cells pool lasts 7-10 days. During this time, the patient is receiving immunosuppressive chemotherapy drugs. The chemotherapy is aimed at suppressing the patient's own immune system, which will allow CAR T-cells to fight the tumor more effectively.
Day 13. Manufactured CAR T-cells are tested for the microbiological safety and functional activity. After the successful testing completion, the solution with CAR T-cells is administered to the patient intravenously.
Day 14 and other days. Control examination and further medical supervision in the hospital are carried out. If there are no side effects of CAR T-cell therapy, a stable tendency towards normalization of blood count is observed and the patient has stable general health condition, the patient is discharged from the hospital. Before the discharge, the patient receives the detailed recommendations for further follow-up during the disease remission.
- Complete blood count with white blood cell count
- Biochemical blood test (renal and liver function tests), if available
- Bone marrow biopsy results
- CT scan, if available
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About the department
The Department of Hematology, Hemostaseology, Oncology and Pulmonology at the University Hospital Muenster offers the full range of diagnostics and treatment of blood diseases, including oncopathologies and blood coagulation disorders, lung diseases, and rare malignant diseases. The department incorporates two modern Bone Marrow Transplantation Centers. In addition, the department belongs to the largest medical facilities in Germany, which specialize in the treatment of malignant lymphomas, acute leukemias, sarcomas, as well as bone marrow transplantation. The physicians of the department are committed to providing patients with the comprehensive medical care of the highest quality, based on the respective attitude towards patients. The Chief Physician of the department is Prof. Dr. med. Georg Lenz.
One of the key focuses of the department is bone marrow transplantation. This procedure has been carried out here since 1999, therefore, the department’s specialists are proud of their exceptional experience in this field. The department was the first in Germany to receive the prestigious JACIE certification, which confirms the highest medical standards of the European level. The specialists of the department perform more than 150 bone marrow transplantations in adults annually, while ensuring the best possible safety for patients. The bone marrow transplantation is indicated in case of diseases, such as acute and chronic forms of leukemia (AML, ALL, CML, CLL), myeloproliferative diseases, lymphomas, including Hodgkin's lymphoma, severe aplastic anemia, multiple myelomas, etc.
Another, but not less important department’s clinical focus is the treatment of oncological diseases. The therapeutic options in this field comprise all modern and the most effective methods. These include conventional types of chemotherapy, immunotherapy with checkpoint inhibitors, targeted therapy of tumors with monoclonal antibodies and small molecules, combined chemoradiotherapy (for example, in the case of lung cancer). In addition, the patients of the department can participate in clinical trials of the most advanced drugs, which can show a positive dynamics even in the most complex and severe clinical cases. The service range is complemented by palliative care, which is used to relieve pain and improve the quality of life of patients, psycho-oncological support, which helps patients to cope with the emotional upheaval and maintain a positive attitude throughout the entire therapeutic process.
In the field of hemostaseology, the physicians of the department provide the diagnostics and treatment of all blood coagulation disorders, which can lead to complex, and, in some cases, irreversible consequences, if not treated timely.
The pulmonologists of the department specialize in the treatment of a broad range of lung diseases and pathologies of other organs affecting the lungs. When treating cancer, the department maintains close cooperation with the experts from related specialties (within the framework of the interdisciplinary tumor boards), which allows them to develop optimal treatment strategies tailored to the specific clinical indications. In the clinical practice, all means of flexible and rigid endoscopy are actively used both for diagnostic and therapeutic purposes, as well as pleural drainage, right heart diagnostics, and ultrasound-guided biopsy.
The department’s range of services includes:
- Diagnostics and treatment of malignant hematological diseases and oncopathologies of the internal organs
- Chemotherapy to treat all types of cancer (both on an inpatient and outpatient basis)
- High-dose chemotherapy
- Immunotherapeutic methods, for example, the administration of immunoglobulin in the case of autoimmune diseases or immunoglobulin deficiency, administration of antibodies in the case of tumor diseases
- Targeted therapy, novel means of molecular therapy, for example, the administration of Imatinib in the case of chronic myeloid leukemia
- Combined chemoradiotherapy
- Treatment within the framework of clinical trials
- Palliative care
- Psycho-oncological support
- Bone marrow biopsy
- Spinal fluid biopsy
- Diagnostics and treatment of benign blood diseases and blood coagulation disorders (for example, thrombosis)
- Diagnostics and treatment of lung diseases with a special focus on:
- Alpha-1-antitrypsin deficiency
- Immunodeficiency states associated with lung diseases
- Interstitial and rare lung diseases
- Cancer of the lungs and other thoracic organs
- Conditions before and after lung transplantation
- Pulmonary arterial hypertension
- Other diagnostic and therapeutic option
Education and Professional Career
- 2002 - 2005 Assistant Physician in the Department of Hematology and Oncology, Grosshadern Hospital, Ludwig Maximilian University of Munich.
- 2005 - 2009 Postdoctoral Fellow in the Laboratory of Dr. Louis Staudt at the National Cancer Institute, Bethesda (USA).
- 2009 - 2014 Professor of "Molecular pathogenesis of malignant lymphomas" at the University Hospital Charité Berlin.
- 2012 - 2013 Senior Physician in the Department of Hematology, Oncology and Tumor Immunology at the University Hospital Charité Berlin (Campus Virchow Hospital).
- 2013 - 2014 Head of the Department of Hematology, Oncology and Tumor Immunology at the University Hospital Charité Berlin (Campus Benjamin Franklin).
- 2014 - 2017 Head of the Department of Translational Oncology at the University Hospital Muenster.
- Since 08.2017 Head of the Department of Hematology, Hemostaseology, Oncology and Pulmonology at the University Hospital Muenster.
- Investigation of the molecular pathogenesis of malignant lymphomas.
- Identification of new oncogenes in malignant lymphomas.
- Supervision of clinical studies, optimization of the therapy of hematological neoplasias.
Photo of the doctor: (c) Universitätsklinikum Münster
Accommodation in hospital
- Program [Description]
Treatment of acute myeloid leukemia (AML) with CAR T-cell therapy
- Hospital: University Hospital Muenster
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