By the time he boarded an airplane to travel across the country to Seattle Cancer Care Alliance (SCCA) in 2019, D.J. Blackrick had exhausted the standard treatments for multiple myeloma.
After being diagnosed in 2017 in Pittsburgh, where he lived at the time, he was treated with chemotherapy, which worked for a while. A successful stem cell transplant followed, but then the cancer returned in the summer of 2018. Multiple rounds of immunotherapy and radiation were unable to get Blackrick’s disease under control, so he tried three rounds of high-dose inpatient chemotherapy to slow the cancer’s spread.
A clinical trial offering access to approaches under investigation seemed to be his only real hope. When Blackrick explored potential trials, he cast a wide geographic net. The only trial he qualified for was 2,500 miles away at SCCA, under the guidance of Dr. Andrew Cowan. If he traveled to Seattle, Blackrick would receive CAR T-cell therapy, which would re-engineer his body’s own cells, then reinfuse them to fight his disease.
It was his last option, the only therapy he hadn’t yet tried. “I had no choice,” says Blackrick, who is 46 and a father of two. “It was either the trial or I was going to be gone. The cancer was taking over my bone marrow. It was getting to the point where I was so weak and in so much pain, I didn’t know how much longer I had. My body was going to start shutting down."
“Basically Dr. Cowan saved my life by accepting me into the trial,” he says.
Most CAR T-cell clinical trials don’t accept patients whose cancer has spread to their brain or spine because of potential neurologic toxicity that can be associated with CAR T-cell therapy’s side effects.
At SCCA, Dr. Cowan took a different approach. SCCA’s trial did not automatically exclude patients such as Blackrick with a history of central nervous system involvement. Their guidelines were more accommodating, allowing patients with no active neurologic involvement to apply for consideration.
“We’ve tried to be as progressive as possible when writing eligibility criteria so that we don’t exclude patients who could potentially benefit,” says Dr. Cowan.
The particular trial that Blackrick participated in emerged from research conducted by SCCA physician Dr. Damian Green at Fred Hutchinson Cancer Center.
The research was designed to assess if gamma secretase inhibitors—first developed to treat Alzheimer’s but since repurposed to fight cancer—prevent plasma cells from releasing a protein called BCMA, which is the target of the CAR T cells.
“The idea—which is based on pre-clinical work done at Fred Hutch—is if we can increase the target on plasma cells, the CAR T cells can potentially work better,” says Dr. Cowan. “Dr. Green’s pre-clinical work, as well as data from our trial, showed that gamma secretase inhibitors can increase BCMA on the plasma cells. The results look very promising. This is a great example of translational research done at Fred Hutch that led to a novel treatment combination that could potentially benefit patients.”
By the time Blackrick arrived in Seattle in July 2019, his plasma consisted of about 90% cancer cells. He was weak enough that he relied on a cane, and he was on pain medication around the clock. For the next couple months, Dr. Cowan and his medical team worked to treat Blackrick to the point that he was stable enough to receive CAR T cells. Radiation was required to treat tumors in his eyes.
“We weren’t sure CAR T would even work,” he says. “I was in really bad shape.”
His children, now 7 and 10, came to visit; his wife was scared that Blackrick wouldn’t make it home. But after beginning CAR T therapy in September 2019, he watched in amazement as plasma cytomas, beet-red welts all over his body, started disappearing. “The doctors were like, wow, this is great,” he says. “CAR T brought me back to life. All the tumors in my bone marrow were gone by the time I walked out of there.”
Blackrick, who owns two School of Rock music performance schools in Pittsburgh, has since moved to Jacksonville, Fla., where his care is overseen by local oncologists and a specialist at Emory University. But he keeps in touch with Dr. Cowan, updating him on his life. After a couple radiation treatments for very small plasma cytomas, he has been in remission for over a year.
“I see all these new treatments as stepping stones to keep this cancer at bay and allow multiple myeloma patients to live much longer than in the past,” says Blackrick. “I believe one day there will be a cure, and I plan to fight this disease every step of the way until we find it.”
Feeling strong and healthy, he recently participated in a 3.3-mile Spartan obstacle course race and works out daily. "I heard that CAR T was saving people, and that was the only option I had,” says Blackrick. “I am living proof that it can save your life.”
