In early 2019, 60-year-old homemaker Madam Azizah went for her regular annual mammogram check-up. When abnormalities were detected, she thought she might have breast cancer. Instead, she was diagnosed with the blood cancer, lymphoma.
She was referred for treatment under the care of Professor William Hwang, Medical Director of the National Cancer Centre Singapore (NCCS) and Senior Consultant in Singapore General Hospital's (SGH) Department of Haematology. With strong family support, Madam Azizah went through six cycles of chemotherapy.
A week after her last round of chemotherapy, Madam Azizah started to develop rashes and nausea. Sensing something was wrong, she rushed to see Prof Hwang, who immediately admitted her. It was then that she discovered a lump in her armpit. Madam Azizah's lymphoma had relapsed.
Unsure about what to do when she received this devastating news, she turned to Prof Hwang for advice. He suggested that she enrol on a clinical trial for CAR-T cell therapy – a novel type of cell therapy and one of the most promising approaches in regenerative medicine.
After many discussions with her husband and son, Madam Azizah decided to join the trial. She spent most of December 2019 in SGH, during which her T-cells were separated from her blood, trained to recognise the lymphoma and then expanded and administered back into her body as therapy.
It was a difficult period when both Madam Azizah and her family struggled with the time apart and the uncertainty of how she would respond to the treatment. Now, over a year after receiving the therapy, Madam Azizah said she feels healthy and is happy and thankful to be alive. She credits her family and Prof Hwang for their support, which got her through it all.
Madam Azizah (centre) was able to celebrate this past Hari Raya with her family after undergoing cell therapy for lymphoma.
Cell therapy as a revolution
Cell therapy is a new field of medicine that transplants cells into patients to act as living drugs by using cells that can that continue to grow and exert their effects in patients for the long term. There are two main types of cell therapy. The first is cellular immunotherapy, which provides immune cells to fight cancer, and infectious disease by resetting and training immune cells. The other is cellular regenerative medicine, which is a fast-growing area of medicine that restores, repairs or replaces damaged cells, tissue or organs in the body. This is particularly relevant for conditions that progress such as heart disease, eye degeneration and neurological disorders.
"Cell therapy has been a big revolution in medicine, and many patients around the world, like Madam Azizah, are benefitting from the use of cells for treatment," said Professor William Hwang, who is also Head of the newly formed SingHealth Duke-NUS Cell Therapy Centre. "Many are also benefitting from the use of cells to restore sight and heal damaged skin. Future uses in heart and brain disease are also very promising."
In the past, patients with large B-cell lymphoma, like Madam Azizah, had limited treatment options if they did not respond to conventional chemotherapy. However, CAR-T cell therapy, trialled in the SingHealth Duke-NUS Academic Medical Centre, is now a treatment option. SGH is the first site in Southeast Asia to offer CAR-T cell therapy for patients with B-cell acute lymphoblastic leukaemia and diffuse large B-cell lymphoma who have relapsed or exhausted other therapy options.
Focused efforts in regenerative medicine
To establish a pipeline of more therapies in cell therapy and regenerative medicine to improve patient care, the Academic Medical Centre has launched the SingHealth Duke-NUS Regenerative Medicine Institute of Singapore (REMEDIS) and the SingHealth Duke-NUS Cell Therapy Centre (SDCT). Announced in May 2021, REMEDIS and the SDCT leverages the multidisciplinary research capabilities, latest platform technologies and facilities within the Academic Medical Centre to champion research, clinical trials, and treatment in cellular and gene regenerative medicine.
All smiles at the launch of the SingHealth Duke-NUS Regenerative Medicine Institute of Singapore (REMEDIS) and SingHealth Duke-NUS Cell Therapy Centre (SDCT). Clockwise, from left to right: SDCT Principal Lead for Education Assistant Professor Francesca Lim, SingHealth Group CEO Professor Ivy Ng, SDCT Head Professor William Hwang and REMEDIS Director Professor Teh Bin Tean.
REMEDIS will harness the potential of regenerating cells, tissue and organs as therapies and tools to tackle age-related diseases and chronic conditions. Its focus will be on seven disease areas: musculoskeletal diseases, bone marrow disorders, blood disorders, cardiovascular diseases, acute and chronic wound healing, neuro-sensory diseases and eye diseases. While SDCT will bridge the gap between research and clinical care by taking the cellular and regenerative therapies into clinical trials and translating them into applications that can benefit patients, such as the CAR-T cell therapy that's now available at SGH.
"The possibilities of cellular and regenerative medicine are limitless, and REMEDIS and SDCT will continue to champion related new areas to improve treatment for patients. In addition to cancer, areas we will explore in the future include wound healing, trauma and chronic disease management," said Prof Teh Bin Tean, Director of REMEDIS, Principal Lead of Regenerative Medicine at the SDCT and Deputy Medical Director (Research) at NCCS.
The establishment REMEDIS and SDCT is set to introduce more novel therapies to benefit patients and give them hope for better treatment outcomes.
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