Working together, White Plains Hospital and the Montefiore Einstein Comprehensive Cancer Center are leading the way in providing cellular therapies to a growing number of blood cancer patients.
CAR T-cell therapy may not be a well-known treatment—yet—but a growing number of physicians and patients alike are swearing by the life-changing, and often life-saving, hope it offers to patients with various types of blood cancers. The cutting-edge CAR T therapy, which stands for chimeric antigen receptor T-cell therapy, modifies a patient’s immune cells to help identify and destroy cancer cells, is available in only about 3.8% of the nation’s 6,120 hospitals, according to the Blood & Marrow Transplant Information Network (BMT InfoNet), a leading advocacy organization for transplant and CAR T-cell therapy.
Through its Center for Cancer Care, White Plains Hospital is collaborating with Montefiore Einstein on this breakthrough therapy. Patients undergoing CAR T through White Plains Hospital receive chemotherapy at the Hospital and then go to Montefiore Einstein for treatment, one of a handful of hospitals in New York State approved for the innovative new therapy.
White Plains Hospital has added CAR T to the full suite of cancer treatments available to area patients. In addition to traditional services like medical oncology, surgical oncology, chemotherapy, and radiation oncology, the Hospital has been a leading provider of advanced blood cancer treatment options such as stem-cell transplantation, a process that uses a patient’s own stem cells to help fight aggressive cancers.
“It’s so important that White Plains Hospital and Montefiore Einstein can work together and offer advanced services like CAR T and transplants for our patients,” says Dr. Joshua Raff, the director of White Plains Hospital’s Digestive Cancer Program. “These state-of-the-art treatments simply cannot be done in most community hospitals. Our partnership is like having one institution with two geographical campuses.”
CAR T in action
Here’s how CAR T, which was first approved by the FDA in 2017, works: CAR T-cell therapies are customized for each patient by collecting T cells—a type of white blood cell that helps protect the body from infection by eradicating virus cells and other debilitative cells. This is done during a three-to five-hour procedure where the patient is connected through an IV line or catheter to an apheresis machine, which collects the T cells and then returns the remaining blood to the patient’s body. Throughout the procedure, the patient is given blood thinner medication through the IV or catheter to prevent blood clots from forming.
The T cells are then re-engineered in a laboratory to produce proteins on their surface called chimeric antigen receptors (CARs). Once those T cells are grown and multiplied into millions in the laboratory—a process that may take several weeks—they are infused back into the patient through a catheter.
The CAR T cells can recognize and bind to specific proteins, or antigens, on the surface of cancer cells. The aim is for the CAR T cells to continue multiplying in the patient’s body, binding to and eliminating cancer cells.
James DeFonce is one example of a patient currently experiencing the benefits of CAR T-cell therapy. The 82-year-old Harrison resident previously was diagnosed with mantle cell lymphoma in his lymph nodes and was successfully treated through chemotherapy in 2017. However, three years later, the cancer returned and was discovered by Dr. Yael Zack, a Medical Oncologist and Hematologist at White Plains Hospital, who had been involved with DeFonce’s original treatments and had maintained regular check-ins with him.
During a January 2021 virtual visit, DeFonce reported he was having frequent episodes of feeling like ants were crawling along his back. A subsequent scan revealed the return of mantle cell lymphoma—this time in the patient’s brain. Dr. Zack referred DeFonce to Dr. Mendel Goldfinger at Montefiore Einstein, who at first thought brain surgery was the best path forward. Upon further consideration, Dr. Goldfinger realized CAR T was the only viable option. “Mr. DeFonce’s brain and the entire lining of his central nervous system were infiltrated with the lymphoma,” he says.
“Since Mr. DeFonce was in such great physical shape—looking at him you’d think he’s 20 years younger than he is—we thought CAR T would work for him,” Dr. Zack adds.
To undergo CAR T, DeFonce was treated first at White Plains Hospital and then at Montefiore Einstein. “Dr. Zack and I and all the other clinicians from both White Plains Hospital and Montefiore Einstein are part of one team and we communicate constantly, in real-time, throughout the treatment,” Dr. Goldfinger says.
Just one month after finishing his therapy, DeFonce declared he felt “great” and had already returned to the gym to lift weights.
“This new treatment option is pretty awesome,” Dr. Zack remarks. “The fact that the CAR T team at Montefiore Einstein and here at White Plains Hospital attend the same weekly multidisciplinary patient care meetings means that we can offer this unbelievable level of care—and quickly! We are very excited at the prospect of being able to treat more patients in the near future.”
Expanding treatment options for myeloma
CAR T is also rapidly becoming a preferred treatment option for myeloma, a rare blood cancer that affects plasma cells.
“Stem cell transplant used to be the single most effective therapy for myeloma,” says Dr. Dennis L. Cooper, Chief of Montefiore Einstein’s blood and bone marrow cancer team. “Now I can safely say that CAR T is the preferred therapy. Because it has been approved for use earlier in the patient’s journey, it’s risen by about 200% since 2023.”
Currently, CAR T-cell therapy is available for adult patients with certain types of Hodgkin and non-Hodgkin lymphoma, multiple myeloma, and leukemia. To be eligible for CAR T-cell therapy, patients typically do not respond to standard therapy or have relapsed after at least two other kinds of treatment. “We are learning more and more about it,” Dr. Raff affirms. “The potential is certainly there for so many patients.”
As White Plains Hospital and Montefiore Einstein Comprehensive Cancer Center continue to make great strides in the fight against blood cancers, the commitment to remain at the forefront of providing the services to patients in need is clear.
“Because coordination with our academic colleagues is seamless, our patients are getting the best of both worlds – advanced oncology care in their community shared with cutting-edge treatments at Montefiore Einstein,” says Dr. Raff.
CAR T Patient Spotlight: Francis O’Connell
Getting Back to Health
Francis O’Connell’s most valuable advocate, he says, is his wife. Last year, the 71-year-old Dobbs Ferry resident, whose lymphoma in his stomach was successfully treated through chemotherapy 10 years prior, started experiencing sudden sharp pains in his back that would come and go. “After about a month of that, I was to the point where I couldn’t walk for any length of time. I was willing to wait it out, but my wife pretty much forced me to go to the Hospital, he says.
The doctors at White Plains Hospital ran an MRI and found a suspicious spot on his spine, which turned out to be lymphoma—the same cancer he had years before. A consultation about spine surgery with the Hospital’s Director of Minimally Invasive Neurosurgery Dr. Virany Hillard was followed by a separate conversation with Dr. Joshua Raff, who in turn referred O’Connell to Montefiore Einstein’s Dr. Dennis Cooper.
Dr. Cooper says the collaboration between hospitals in the Montefiore Health System “is a model of how this treatment should work. An oncologist may recommend CAR T, but they don’t necessarily have a center that can provide the therapy onsite.
“In this patient’s case, given the spinal compression issues and his age (around 70), using stem cell therapy was considered too difficult and dangerous,” he continues. “We explained CAR T to him and he was onboard. Instead of very aggressive chemotherapy, he received some radiation that was done locally by his own oncologist. He was at White Plains Hospital for three days and then came to Montefiore Einstein for CAR T therapy, where he spent a couple of weeks. We usually keep patients here for 10-12 days but in the future, I anticipate we’ll do it on an outpatient basis.”
While still in treatment, O’Connell is feeling well and appreciative of the coordinated care he is receiving. “I am so grateful,” he says. “I’m still going through rehab but feel so much better—I couldn’t walk for so long and I have a new lease on life.”
CART T Treatment Patient Spotlight: Richard Reid
The Best Patch Forward
Sitting in White Plains Hospital’s infusion center during one of his treatments for multiple myeloma, Richard Reid notes that he has been through a lot: 15 spinal surgeries—including five spinal fusions resulting from a car accident—and innumerable chemotherapy sessions, culminating in his first being diagnosed with multiple myeloma in 2021.
The 69-year-old Stamford resident was originally scheduled to begin therapy at another hospital, but he was “a little frustrated” by its lack of communication. Instead, he came to White Plains Hospital, where his daughter Hayley Reid, BSN, RN-BC, OCN, is a nurse.
When Reid first arrived at White Plains Hospital in 2021, CAR T had not yet been approved for myeloma, explains Dr. Cooper of Montefiore Einstein Comprehensive Cancer Center’s blood and bone marrow cancer team. Instead, it was determined that an autologous stem cell transplant was the best course of action. This popular treatment for blood cancers—dating back to the 1950s—involves harvesting healthy blood stem cells from a patient’s blood or bone marrow before chemotherapy. Those stem cells are then frozen, and transplanted back into the patient once chemotherapy has been concluded.
“My immune system was shot,” Reid says of his early days at the Hospital. “I got pneumonia in the middle of everything. So when the doctors explained the stem cell treatment to me, I was ready—and it’s worked out just great.”
Reid’s treatment team included Dr. Carol Lederman, a Hematologist and Oncologist at White Plains Hospital, and Montefiore Einstein’s Dr. Mendel Goldfinger. “They were very thorough and caring, which meant a lot,” Reid says. “I’m so thrilled with the treatment I’ve received here,” he adds. “They treat you like a person, not a number.”