First Oklahoma Children's Hospital Patient Treated With CAR-T Therapy Receives New Hope in Battle Against Leukemia

This spring, five years after his diagnosis with acute lymphoblastic leukemia, Ryan VanZandt experienced his second relapse, the type of bad news that typically would mean his treatment options had run their course. However, the return of his cancer coincided with the arrival of a new immune therapy at Oklahoma Children's Hospital at OU Health, which is giving new hope to Ryan and patients like him.

This year, Ryan became the first patient at Oklahoma Children's Hospital to receive CAR-T, a new treatment for blood cancers in which a patient's own immune cells are genetically modified to recognize and attack cancer cells. Since receiving CAR-T, Ryan has been in remission and will be able to spend the holidays at home with his family for the first time in years.

"This revolutionary new treatment successfully eliminated Ryan's leukemia, and it did so by attacking only the cancer cells, not the normal cells in his body," said Rikin K. Shah, M.D., interim director of pediatric transplantation and cellular therapy at the Jimmy Everest Center at Oklahoma Children's Hospital. "This treatment is changing the landscape of pediatric cancer treatment because it is giving an opportunity for survival for those patients who had run out of treatment options."

CAR-T stands for Chimeric Antigen Receptor T-cell therapy. Patients being treated with CAR-T first have their blood collected in a process similar to a typical blood donation. White blood cells (which include T cells) are filtered out and sent to a company that inserts the gene for a chimeric antigen receptor into the T cells, which binds to cancer cells and activates the T cells. This process allows the newly engineered T cells to recognize and attack cancer with remarkable efficiency. Once the CAR-T cells are generated, they are shipped back to the hospital and given to the patient through an IV, much like a blood transfusion.

Ryan's long journey with acute lymphoblastic leukemia, or ALL, began in August 2015. A typical teenager and a high school athlete in Duncan, Ryan was running on a freshly mowed track during cross-country practice when he became exhausted and couldn't finish his lap. In the days ahead, he became increasingly tired and sleepy and quit hanging out with his friends. He even lost interest in playing games on his Xbox, one of his favorite things to do.

After his diagnosis with ALL, Ryan received chemotherapy at Oklahoma Children's Hospital for nearly three-and-a-half years, a standard length of treatment to ensure the cancer doesn't return. Ryan faced complications during that time, including serious bouts with pancreatitis, but at the end of his chemotherapy, in January 2019, he was declared cancer-free.

"I was feeling pretty good," Ryan said. "I rang the bell at the hospital," a tradition for patients who are free of cancer.
But the good news was short-lived. Four months later, in May 2019, Ryan's leukemia returned in his spinal fluid. He started back on chemotherapy, and again the cancer cells were eliminated. He stayed on a chemotherapy regimen, but a year later, in May 2020, he had a second relapse, this time in his bone marrow and his spinal fluid. That's when his doctors decided he was a candidate for the new option of CAR-T

"The success rate of treating acute lymphoblastic leukemia with chemotherapy in young people is usually very high. The problem is that when patients have a recurrence, the outcomes are dismal," Shah said. "That's why CAR-T is so important - because it allows us to help patients whose cancer would otherwise be deemed incurable. And Ryan was able to have CAR-T therapy in Oklahoma instead of going out of state, which would bring an additional burden of travel and finding housing for a month."

Although CAR-T therapy has cleared his body of cancerous cells, Ryan's treatment for ALL is not quite over. Next year, he will have a bone marrow transplant from his sister Savannah, who is a perfect match for the donation of a brand-new immune system. However, the transplant would not be possible without Ryan first receiving CAR-T.

"Patients are not eligible for bone marrow transplants when they still have leukemia cells, and because Ryan had relapsed, he still had cancerous cells," Shah said. "CAR-T therapy allowed us to put his leukemia into remission so that he will be able to have the transplant."

As CAR-T continues to be studied, it will likely help patients at several different stages of their treatment, Shah said. For some patients, it will serve as the final treatment and the CAR-T cells will stay vigilant in the body in an effort to eliminate any new cancerous cells. It also may move up earlier in the treatment process, or be used to treat patients whose bone marrow transplants fail.

"This type of immune therapy is going to change the way we treat cancer in the next five years because we are harnessing the patient's own immune cells to fight cancer," Shah said.

Ryan's mother, Bylynn VanZandt, read online about CAR-T before it was approved for use in the United States. Like any mother, she was nervous about her son receiving a new treatment, she said, but the timing was a godsend.

"We were down to some of the last options, so we decided to do it," she said. "It was clear that it would make the transplant possible for him."

Ryan's five years with leukemia have not been easy, his mother said, but their faith, family, friends and church family have supported them in numerous ways. Ryan graduated from Durant High School and has taken classes at Southeastern Oklahoma State University as his health has allowed; he is majoring in business and envisions a career in banking.

"It's definitely been a long journey," Ryan said. "All my friends and family have kept my spirits up. I do my best to look on the brighter side of things. This has given me a new perspective on life, especially to value the people who have cared for and supported me."