Timing was everything for this cancer patient. Scientists had already harvested billions of cells in a cutting-edge lab for months. The doctors had performed a handful of rounds of chemotherapy to weaken the tumor. Now came the most crucial part: infusing those cultivated cells back into the patient. If the experimental treatment worked, Dr. Adi Diab felt the patient might have a shot at beating late-stage melanoma.
The Houston oncologist had his patient travel over 100 miles from Louisiana to be admitted at MD Anderson Cancer Center in advance of the infusion. In the midst of chemotherapy, the storm that would become Harvey slowly spun west through the Caribbean Sea, picked up speed, and crashed into the Texas coast as a Category 4 hurricane with winds up to 130 miles an hour. Harvey made landfall Friday night - just days before the high-stakes procedure had to occur.
Over the weekend, as Harvey dumped feet of torrential rain on Houston, a team of providers at MD Anderson debated whether they'd need to postpone the procedure scheduled for Monday. But not moving ahead would essentially mean starting over. So the team made the call Sunday to find a way to get to MD Anderson the following morning. They did so as flooding turned deadly elsewhere in the city, and despite the fact that parts of the medical center had flooded.
"We always promise our patients one thing: They'll never walk alone," Diab, an oncologist who specializes in melanoma treatment, told STAT. "I didn't know how long it would take. I had to go. I needed to be next to my patient."
Diab was one of six providers - three lab techs, two doctors, and a nurse - who worked with this melanoma patient. On Monday morning, as Brays Bayou poured out into Houston's streets, Diab walked roughly three miles, wading through stretches of shin-deep waters, from his home toward his office.
His patient, who has stage 4 melanoma, is one of about 50 adults enrolled in a Phase 2 clinical trial studying a form of adoptive T cell therapy. Tumors typically prevent the immune system's T cells from tracking down and destroying cancer cells. But Diab said this experimental immunotherapy works by "harvesting" the tumor for any potential T cells. "We like those T cells," he explained. "They're in the cancer for a reason, but weren't able to completely kill the tumor."
By the time he arrived at MD Anderson around 10 a.m., Marie-Andrée Forget, a senior research scientist, was already in the laboratory preparing the harvested T cells for the infusion. Her trek had been less perilous - but she'd left behind a water stain in her ceiling that had grown about 2 feet wide. She didn't know if she'd return to a flooded apartment.
But being there early was important: She had to test 14.5 billion T cells harvested from the patient to make sure it was safe to proceed with the infusion.
"All weekend I'd been super nervous," Forget said. "It was not because of Harvey, or the water stain getting bigger, but the life of the patient. The minute I started processing cells, I was not nervous anymore."
Two months earlier, scientists in Forget's lab took a tumor removed from the patient and cut it into small fragments, placing them onto culture plates. Over the course of several weeks, the T cells grew by the millions until the point where scientist froze the plates until the patient could come in. Two weeks before the infusion, Forget's team transferred the samples into five 1-liter flasks that sat at room temperature to allow the T cells to keep growing. Finally, on the morning of the infusion, the cells were run through a centrifuge, washed clean of culture media, and tested to make sure they were sterile.
"Our therapy is like the army," Forget said. "The [T cells] were outnumbered. In the lab, they go through boot camp, so when we re-inject them into the patient, they [become] soldiers ready to attack the tumor."
With Diab and other team members in place on Monday, Forget concentrated the cells into a single infusion bag - a process that took most of the day to finish. The bag was then transported from the lab to the procedure room. Around 5 p.m., the infusion got underway.
One of Dr. Diab's fellow doctors, who was already on call, ended up handling the infusion. The process works similarly to a blood transfusion, except slower. It usually takes no more than an hour to complete - medical personnel move slowly to monitor vitals and reduce the chances of side effects including fever, chills, or low blood pressure. As the patient receives the harvested T cells, the team also administers a dose of Interleukin-2, a group of proteins designed to boost the immune system during cancer treatment. The goal of it all is simple: give T cells a better shot at defeating cancer.
Diab stuck around to make sure his patient felt all right. The patient did, despite all the uncertainty in Houston and back at home in Louisiana, where his family faced an incoming storm.
"The patient was grateful," Forget said. "It was emotional for us."
Days after the procedure, Diab said his patient ultimately tolerated the treatment well. For the next portion of the clinical trial, the patient will likely undergo a therapy regimen that includes more doses of Interleukin-2 followed by the drug Keytruda, which enables the immune system to assault tumor cells.
The patient's road back to health, like Houston's after Harvey, remains a long one. But Diab and Forget said their team is willing to keep walking with the patient for however long it takes.
"I know this might sound like a heroic story, but this is a regular story that happens in many different flavors for many patients at many other care providers," Diab said. "I'm not trying to be humble. [But] I was not the only one."