CHAPEL HILL When Sabrina Shelton received her college degree in 2007, her thoughts were focused on her future. She considered grad school and going straight into the workforce, looking for housing and starting salaries, but what she didnt expect was a cancer diagnosis.

In April of 2008, Shelton, now 34, of Bedford, Virginia, was diagnosed with acute lymphoblastic leukemia, derailing her plans for the next phase of her life and fast tracking her into a month of cancer treatment, followed by a year of after care.

At the time, youre asking yourself, What do I want to do? What do I want? she said. Its the kind of existential question that were all asking ourselves as we graduated college, and then you get your answer.

For Shelton, her cancer journey started off smoothly. She was in remission within a month of starting treatment and was cancer-free for almost five years a standard cancer survivorship benchmark. But her cancer returned in 2012 and again in 2014. And still again in 2018.

I just wanted to get to that five-year mark so bad, Shelton said. I was of course upset about it and disappointed that it didnt at least get me to the five-year mark, because thats the target number that I wanted. With every recurrence, I do have those moments where when I initially hear about it, Im shocked.

The bulk of Sheltons care had been at the University of Virginia Cancer Center, with the exception of a stem cell transplant with UNC LinebergersPaul Armistead, MD. With her recurrence in 2018, she had exhausted traditional treatment options, so Sheltons care team referred her to UNC LinebergersMatthew Foster, MD, for a chimeric antigen receptor T-cell (CAR-T) therapy clinical trial.

CAR-T immunotherapyuses a patients own immune system to fight their cancer. This involves extracting the patients T-cells, manipulating them to recognize the patients cancer, and then re-infusing them into the patient to attack their cancer cells.

One advantage of these altered T-cells is that they can survive and persist within the body and, not only be an army of cells for one time, but an occupying force, Foster said.

At the North Carolina Cancer Hospital clinic in Chapel Hill, Foster was both optimistic and realistic about Sheltons prognosis, taking time to answer her questions. CAR-T being a relatively new treatment, however, there were not a lot of outcomes and results he could share with Shelton, a self-proclaimed numbers person.

I want to know how many people have had it, how many have survived, how long has it lasted? she said. And they just cant tell me its going to last short term or long term. But the clinical trial itself went way better than I had imagined in my mind of how it would go.

Foster and the cellular immunotherapy team at UNC Lineberger look for new treatments for difficult-to-treat cancers, and Shelton was part of the corresponding study that aimed to make treatments safer.

Fortunately, she had an easier pathway with these CAR-T therapies than she did with her transplant, Foster said. Thats not necessarily true for all patients. There are patients who have had more profound toxicities.

For Shelton, the difference in treatment strategies was significant. With CAR-T, she didnt suffer the same types of side effects she had with chemotherapy and radiation or the lengthy hospital stay and recovery with the stem cell transplant. There was no hair loss; no mouth sores; no bone-deep fatigue. She said her real fear was neurological effects from the CAR-T treatment, but her cognition was unaffected.

The only major thing Ive had was a fever. I never had any of the hallucinations or the other major neurological symptoms, she said. For that to be the biggest side effect that I had, I was certainly blessed.

We see a number of young adults and adolescents with acute lymphoblastic leukemia. Unfortunately, this population is often in the midst of launching themselves from under their parents wings and launching their careers or education, Foster said. Sometimes the parents take an active role, and sometimes the parents dont. Sabrina is fortunate to have supportive parents and a great attitude herself in terms of taking care of herself and trying to blend her care for herself with her career aspirations and personal life.

These days, Sheltons focus is on her life outside of cancer. She enjoys volunteering at a bridal shop that receives donated dresses from high-end shops like Kleinfeld Bridal in New York and gives the proceeds to help women in need. She recently took trips to Colorado and California. Shes even planning to go to New York something she couldnt imagine doing during her initial diagnosis and recurrence.

I see everybody else around me living life. So, I feel like, why cant I? she said. Of course, life can happen in between all of these plans, but Im just not going to sit back and watch life pass me. Im going to get out there as much as I possibly can.

Learn more about theCAR-T Immunotherapy Programat UNC Lineberger.

(C) UNC

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