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“When we learned about CAR-T, we knew it’s what we had to do”

IU Health Simon Cancer Center

“When we learned about CAR-T, we knew it’s what we had to do”

There was a cough that wouldn’t quit. Now Devon Tesler is preparing for a groundbreaking new gene therapy.

As he reclined in the third floor apheresis unit of IU Health University Hospital Devon Tesler talked about life before his diagnosis.

At a very young age his mom, Michelle Byrd recognized a giving heart in her middle child. Devon, 20, has an older sister Kate Tesler, 22 and a younger brother Conner Tesler, 19.

“When he was young if they wanted something, he’d give it to them – Yu-Gi-Oh! trading cards, whatever - he’d save up money and spend it on them,” said Byrd. He’s been known to pay for a friend’s lunch or movie ticket and when the family moved into a new home and his younger brother wanted the bigger room, Tesler relented.

“As a toddler he was completely different than my first baby. All he wanted to do was eat and sleep,” said Byrd. Her middle child weighed in more than nine pounds at birth and when he started to talk he used a deep husky voice said his mom.

A 2017 graduate of Hamilton Southeastern High School, Tesler dabbled in several sports - baseball, football, and hockey – in elementary and junior high. He continued with football his freshman year of high school and then got interested in weight training.

When he dropped a few pounds he thought it was probably due to increased activity.

***

It was last July when the family was taking off for their annual vacation to Traverse City, Mich. that Tesler learned he has Non-Hodgkin lymphoma. He’d been coughing since March and made a couple trips to the doctor. First he was put on antibiotics, then allergy medication. His physician suggested an x-ray just a few days before the family was headed out for their vacation.

“They suggested a second scan so we got them in Michigan and had them sent to IU Health. We had to wait through the Fourth of July holiday before we heard the results,” said Byrd. Within days, Tesler was in the care of IU Health hematologist/oncologist Dr. Hillary Wu. He started six rounds of chemotherapy followed by several rounds of radiology. “It was looking like it was working and then he started coughing again. As we began to prepare for a stem cell transplant, his condition grew worse. Then we learned about CAR-T therapy and we knew we had to do it,” said Byrd.

The innovative gene therapy uses custom-made cells to attack a patient’s own specific cancer. CAR-T cell therapy allows doctors to isolate T-lymphocyte cells – the body’s cells that fight infections and are active in immune response. The T cells are then engineered to express a chimeric antigen receptor (CAR) that targets a protein on a patient’s cancer cells, attaches to them and eventually kills them. Indiana University Health is one of the first sites in Indiana to administer the treatment. One of the first phases in the therapy involved Tesler’s lengthy visit to apheresis to remove his blood plasma, separate the plasma cells, and then reintroduce cells. Tesler is one of the youngest adult patients to receive the innovative therapy at IU Health.

“It’s all a process that we’re learning about. With apheresis they extract Car-T cells then send them to manufacturers. Then in about 21 days they’ll send them back IU to test them and make sure they’re viable before they’ll start chemo again and reintroduce the cells. We don’t expect him to get to the final stage until about four weeks,” said Byrd.

***

Tesler grins as nurse Sarah Isaacs checks on the apheresis progress. This is a better day than others he’s had recently. He’s just finished up a four-day hospital stay – rushed by ambulance with a high fever and elevated heart rate. He’s looking for light at the end of the tunnel.

“When I first heard the words ‘Non-Hodgkin lymphoma’ it was new to me. I knew it wasn’t good. It was surreal,” said Tesler. He was 19 at the time and in his first year of college at IUPU studying health science. He had just been promoted from a bus boy to a server at Bubba’s 33, a restaurant in Fishers, and was enjoying the summer with his high school friends who have scattered to various colleges.

“Of course the first thing that happened was I worried. I worried that I had dismissed a lot of signs – like the chills at night or the sweating or the weight loss. I just thought I’d been chalking it up to other things and here it was something worse than a cough,” said Tesler. He’d had no other serious illness until his diagnosis. In fact, he says the worst thing that ever happened to him was when he was four and a neighbor girl ran over his right leg on her bike and broke a bone.

He worried most about how his friends would accept the news.

“He’s always had a close-knit group of friends. He’d do anything for them,” said Byrd. When they get together they enjoy board games, card games and movies – especially Star Wars. Tesler once gave his own money to buy one of the friends a saber just to see him smile. “Devon’s the type of guy who will open a door to anyone. If five people want a cookie, he’ll give it up and get more,” said Byrd.

He sent a group message to his friends to tell them about his diagnosis. This is the same group who showed up at his house and climbed through a window with food from Taco Bell when he went through a high school break up. That same group showed up again after his first session of chemotherapy.

It’s a different kind of summer, he says. “Normally, I’d be taking trips back to Traverse City and Captiva Island and working security for concerts with my friend. I’d be working and getting ready to go back to school.”

Now, he’s waiting and hoping that this new therapy that he is just learning about will be enough to get him back to good health. And as he waits he chills.

“I’ve done a lot of thinking. I still love making people smile more than anything,” said Tesler. “I guess if I had a life motto I’d say, ‘smile, be positive, help others and be the change you want to see in the world.’”

-- By T.J. Banes, Journalist, IU Health.
Reach Banes via email tfender1@iuhealth.org.

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