More than a year after receiving what was considered an experimental treatment, a Bismarck man is cancer free.
Matthew Jahner is living proof of success of a cell-based gene immunotherapy treatment, Chimeric Antigen Receptor (CAR) T-Cell Therapy, approved by The Food and Drug Administration in August.
The FDA approved Kymriah, which involves using genetically modified immune cells from patients to attack their cancer, to treat children and young adults up to age 25 suffering from a form of acute lymphoblastic leukemia who do not respond to standard treatment or have suffered relapses.
Jahner was enjoying his Christmas break from Dickinson High School in 2008, playing racquetball with friends, when he developed a pain in his ribs. He thought it was a pulled muscle but the pain was waking him up in the middle of the night.
He went to the doctor. They tested his blood. From there, they sent him to have his bone marrow biopsied. He was diagnosed with acute lymphoblastic leukemia.
“I responded well to chemo right away,” Jahner said.
After 3.5 years of chemotherapy, he was declared in remission. Things were going as good as they could have been.
He enrolled at Dickinson State University then transferred to Bismarck State College to study petroleum engineering technology.
In 2013, the pain was back, this time in his sternum.
He had had pains before and each time it filled him with anxiety. This time was different, scarier. This time he knew for sure. The cancer was back.
“It was tough,” Jahner said “I didn’t want to tell my parents.”
He needed a bone marrow transplant, but he had no match.
At Mayo Clinic in Rochester, Minn., his doctors opted for a double umbilical cord stem cell transplant.
He would spend about six months in the hospital, with a serious fungal infection complicating things prior to his treatment. Heavy chemotherapy was used, knocking out his immune system even further, and visitors had to check in before even being allowed to see him.
The treatment worked, using cells from the umbilical cord of a baby girl in Spain. Everything again was going according to plan. His immune system had bounced back and he was in remission for almost two years.
But when the cancer came back for the third time, the clinicians in Rochester told him they had exhausted their resources. There was nothing more they could do.
“Mom and I didn’t know what to do,” Jahner said.
But his sister, who worked in the Intensive Care Unit at CHI St. Alexius Health in Bismarck, had been researching an experimental treatment. She spent weeks on the phone and computer with doctors trying to get him into a trial.
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With her hard work, he would be accepted into a trial at Fred Hutchinson Cancer Research Center in Seattle. They had conducted about 100 at the time.
“They weren’t all successful, but it had a good prognosis,” Jahner said. “People from all over the world were there.”
As far as he knows, he’s the only one from North Dakota to have gone through the treatment.
At the time, Dr. Cameron Turtle, a physician at Fred Hutchinson, told the Tribune the trial has been going on for two and a half years. Patients in the trial were required to stay in Seattle for two months then were monitored for a year.
“We’re scared; we’re very scared," Erin Jahner, Matt Jahner’s sister told the Tribune in April 2016. "But without this, we don’t have any other options at this point."
Matt Jahner had faith in his sister but having total confidence wasn’t possible after so many relapses.
“Numbers don’t mean much to me anymore,” he said.
But, now 26, Jahner is back to hunting, fishing and doing the things he loves. He has a job as a teller at Dakota Community Bank. He’s good with numbers. He’d like to be a loan officer one day. And he finished his degree at BSC in case oil activity picks up again.
The treatment Jahner received involves removing some of the patient's T-cells, which are part of the immune system; engineering them in a lab to recognize and kill cancer cells; and then reinjecting them into the patient, said Dr. Peter Kruniali, who isn't Jahner's doctor but who has worked as an adult oncologist, specializing in hematology, at Sanford Health in Bismarck for three years.
Jahner said he received chemotherapy before to make room in his marrow for the T-cells.
The treatment does have side effects, including an overreaction by the immune system known as cytokine-release syndrome. As a result, the FDA issued strong warnings with its approval.
As the treatment was working, Jahner ran a fever, 104 degrees for five days. He remembers some of it — shivering under an ice blanket, back pain from where the cancer was affecting his vertebrae.
“There were a couple days I didn’t know where I was,” Jahner said.
Immunotherapy treatments, such as CAR T-Cell Therapy, could be the future of cancer treatment, according to Kruniali, who said, while CAR T-Cell is an adoptive cell therapy, there are other forms of immunotherapy also showing promise.
Some of the immunotherapy treatments he has worked with are different in that they stimulate cells to work better to attack cancer and removes the cancer cells' ability to block the immune system and remain undetected in the body.
Some of these treatments have had FDA approval for the past five years.
"When (immunotherapy) was initially approved, it was as a last line," Kruniali said. "But now what we see trending is immunotherapy starting to climb the ladder and being given in an even earlier phase."
And Kruinali said having patients in Bismarck who are examples of immunotherapy's success opens the door for even more local cancer patients to benefit.