When Robert Reinkenecht retired at 58 from a career in accounting, he pictured spending leisurely days on the shore watching the waves and playing volleyball with his wife near their new house in Long Beach, New York.
But in late 2014, a recurring pain in his back led to a diagnosis of multiple myeloma, a blood cancer in which abnormal plasma cells build up in the bone marrow and form tumors in many bones of the body. The disease is treatable, but there is no cure.
Robert took a drug called lenalidomide, which worked at first. After two years, however, the cancer came back and was resistant to further treatment.
“I felt sadness and shock,” Robert says. “I thought, ‘Well, you lost.’”
But he refused to give up and sought help at Memorial Sloan Kettering. Doctors performed a bone marrow transplant using Robert’s own stem cells. It held the disease at bay for a while, but in 2018, the multiple myeloma returned yet again.
Not long ago, Robert would have been out of options. But his MSK doctor, medical oncologist Sham Mailankody, told him about a revolutionary new immunotherapy for multiple myeloma called chimeric antigen receptor (CAR) T cell therapy. CAR T therapy involves removing immune cells called T cells from a patient, arming them with synthetic proteins that allow them to recognize and attack cancer, and then returning them to the patient in large numbers.
At the time, Dr. Mailankody was leading a clinical trial testing CAR T cell therapy in people with multiple myeloma who, like Robert, had stopped responding to other therapies.
Robert had no hesitation. “After the transplant didn’t work, I said ‘I’m going try anything they’ve got,’” he recalls. “I felt very relaxed around Dr. Mailankody. I trust him and I trust MSK.”
Pioneering the Field
MSK researchers have long been pioneers in using CAR T therapy: In 2006, they launched one of the first clinical trials in the US for the new treatment. By 2017, CAR T therapy had been approved by the US Food and Drug Administration for treating certain leukemias and lymphomas. Now, several new kinds of CAR T therapies are showing great potential for multiple myeloma as well.
For his treatment in 2018, Robert joined the phase I/II clinical trial Dr. Mailankody was leading in collaboration with Juno Therapeutics, Inc. In this CAR T therapy, the T cells are engineered to target a protein called BCMA, which is found in abundance on multiple myeloma cells but is absent from nearly all normal cells. Two similar trials are in progress at MSK, with slightly different versions of CAR T cells engineered to home in on BCMA.
MSK researchers are optimistic about this BCMA-focused CAR T strategy. In March 2021, the FDA approved a CAR T cell treatment that targets BCMA called idecabtagene vicleucel (Abecma®), which was developed by Bluebird Bio and Bristol Myers Squibb.
“BCMA is showing great promise as a CAR T cell target in people with multiple myeloma,” says Dr. Mailankody. “We are seeing patients respond very well to this when all other treatments have failed.” In addition to the CAR T trials, MSK has trials evaluating other strategies to target BCMA.
Robert came to Memorial Hospital in the summer of 2018 to have T cells collected from his blood so they could be engineered to target BCMA and stop the cancer. On August 30, doctors infused the genetically modified T cells back into his body.
“It was Labor Day weekend and my friends from Long Beach were all on the beach, calling me at the hospital and saying, ‘Hey Bobby, what’s going on?’” recalls Robert, “And I would say, ‘I’m alive.’”
Having already gone through a stem cell transplant made the CAR T infusion a bit less intimidating for Robert. “The CAR T treatment was easier to tolerate than the transplant,” he says. “I did not feel bad from the effects, other than a slight fever I had at the very end of my stay. And I didn’t lose my hair like with the transplant.”
After the infusion, Robert quarantined at Memorial Hospital for a few weeks and then at his Long Beach home for several more. He says overall the recovery was not difficult.Back to top
The Next Chapter
The myeloma stayed in remission for two and a half years. Robert was able to stay active and fully enjoy retirement.
“We would go to the beach constantly and hang out with friends — I watched volleyball rather than playing, but we would have a great time,” he says. “I also enjoyed doing yardwork and gardening.”
In the spring of 2021, there were signs that his disease was slowly beginning to return. After conferring with Dr. Mailankody, Robert enrolled in a second clinical trial. In this study, the CAR T cells are engineered to target a new protein called GPRC5D. Like BCMA, GPRC5D is present on the surface of multiple myeloma cells in most patients, but not normal cells. Robert is set to receive the GPRC5D-directed CAR T therapy in July 2021.
“I feel very lucky about everything,” he says. “Thank God there are brilliant scientists and doctors who have been working on this. If it had happened to me 20 years ago, I don’t think I’d be alive.”Back to top