After everything Gary Gardiner Jr. went through during 18 grueling months—when conventional treatments didn’t work and a new immunotherapy with dangerous side-effects became his only option—he might want to put the subject of cancer behind him.
But the detective-turned-real-estate-broker is determined to share his “true miracle” story. He and his wife, Teresa, who was at his side through every needle stick and scan, have reached out to others facing the disease and become patient ambassadors for CAR T-cell therapy, a treatment in which a patient’s own cells are genetically altered to attack the cancer.
“We’re doing everything we can do—articles, videos, we spoke in Washington about making CAR-T more affordable,” said Gary. “We want to give back to the community that saved my life.”
That includes thanking co-workers at Coldwell Banker Elite, where he’s a managing broker of 32 agents. Before the couple started their own real-estate firm in 2015, Gary, who is 50, spent 26 years as a homicide detective and child-abuse investigator in Prince William County and with the National Center for Missing and Exploited Children in Alexandria.
Realtors kept his business going during his illness while family, friends and law-enforcement colleagues helped with donations and food. The couple was able to focus on treatment without constantly worrying about their part of medical bills, which totaled $38,000 the first year alone.
“We’re going to be indebted to them for the rest of our lives,” he said. “There would have been no way we could have done this without them.”
The Gardiners also are grateful that Dr. Sudeep Menachery of Hematology Oncology Associates of Fredericksburg was on call the first time Gary was hospitalized. Menachery shepherded the Gardiners through local treatments, radiation in Charlottesville and immunotherapy treatment at the University of Maryland’s Greenebaum Comprehensive Cancer Center in Baltimore.
“The way things worked out was amazing,” Teresa said.
Even so, Menachery said he had more than one “oh-no moment” when conventional treatments couldn’t touch Gary’s growing tumor.
“If this had been a couple years ago,” Menachery said, “I think Gary would have died.”
‘EVERYBODY WAS SHOCKED’
The Gardiners live in Caroline County, operate their business in Massaponax and have two sons: Gary III, 26, and Brandon, 24, both graduates of West Virginia University.
Around Christmas 2016, the flu made its way through the Gardiner household, and everybody but Gary recovered. That was odd because he wasn’t the kind of person who got sick.
In the few times he’d been under the weather during the couple’s 27-year-marriage, he’d let whatever bug bit him run its course without any over-the-counter cures. When his cough and headaches continued, Teresa urged him to visit a walk-in clinic.
Gary did and was diagnosed with a sinus infection.
When the problem persisted—and Gary’s face puffed and his eyes swelled shut as he slept—he took a dose of Benadryl each morning and went to work. When he developed a knot in his throat, he went back to urgent care and was told it was nothing to worry about.
The couple scheduled tests and an appointment with an ear, nose and throat specialist.
“The doctor came in with his laptop and said, ‘I don’t know how to tell you this, but you have cancer,’” Gary said. “And he showed us a large, almost softball-size mass in my chest, if you can believe it.”
The Gardiners were sent straight to Mary Washington Hospital for a biopsy. Tests showed he had diffuse large B-cell lymphoma, a cancer of the white blood cells and the most common non-Hodgkin’s lymphoma worldwide. It’s also highly treatable.
Menachery started the standard regimen, an aggressive combination of six chemotherapy drugs, given over 4 1/2 months. Two months later, another scan was taken.
“Everybody was shocked that I still had cancer,” Gary said.
‘AS IF HE WERE NEVER SICK’
Turns out Gary had a subtype of lymphoma, a highly aggressive form that’s present in about 2 percent of non-Hodgkin’s cases. Menachery consulted with other doctors, and specialists at the University of Virginia Health System suggested radiation because his tumor was so concentrated.
Gary finished his 30 days of radiation in November 2017 and felt like himself again, so he and Teresa planned a trip to the beach.
When the headaches returned, Gary sensed the tumor again was pressing against the superior vena cava, a major blood vessel in his heart. Before his diagnosis, pressure against the vein backed up the blood in Gary’s right arm and the right side of his face and caused the swelling, Menachery said.
Clients who listed their homes with Gary saw the way his cheeks puffed up and his hair fell out from treatment because he worked whenever he wasn’t in the hospital—even sometimes when he was.
“A lot of my clients said, ‘Gary, you look really different but you sound exactly the same,’ ” he said, laughing. “If you can believe this, we still ran a successful real estate business through the entire treatment. I was literally working from the chemo chair.”
Others in the Coldwell Banker Elite office filled in when he couldn’t be there, and their main concern was if Gary was getting enough rest, said Deb Ellis, the office’s vice president of residential sales.
“He acted as if he was never sick. He came in with a big smile every day when he was allowed to work and be around the public,” she said. “He knew he had a fight for his life in front of him, but you would never have known it, meeting him.”
When he got the news that a treatment hadn’t worked, he simply said: “Let’s move on, we’re gonna try the next thing,” Ellis said.
That was Gary’s reaction when Menachery told him the radiation hadn’t shrunk the tumor. Lymphoma specialists suggested a bone marrow transplant next, using bone marrow harvested from Gary and later returned to his body after high doses of chemotherapy killed his cancer-ridden marrow.
But they wanted another round of chemo first. Four drugs, different from the first round, were administered, and this time, the news was even worse.
Gary’s cancer had become resistant to chemo, which meant a bone marrow transplant would do him no good.
“His cancer never went into remission,” Menachery said, adding that he and his colleagues see a tumor “every once in a while” that doesn’t respond to standard treatment. “That’s what was the scariest.”
‘A ROBUST REACTION’
The only option left was CAR-T cell therapy, and it’s not a treatment to be taken lightly.
CAR-T was approved by the U.S. Food and Drug Administration in October 2017 for lymphoma patients whose cancers don’t respond to at least two kinds of treatment. When the Gardiners considered it in spring 2018 and selected the University of Maryland facility, Gary learned patients had died during clinical trials.
T-cells are white blood cells that are part of the body’s immune system and attack infected cells. But cancer cells are tricky; they can hide or secrete a substance that keeps the body’s T-cells from finding them, Menachery said.
The therapy involves removing a person’s own T-cells, and Gary had to sit perfectly still through a six-hour process in which he had needles in both arms. Then, the cells were sent to a lab, where they were genetically engineered to attach themselves to a protein in the tumor and kill the cancer cells, according to a story about Gardiner in the University of Maryland’s Catalyst magazine.
Others have compared the beefed-up T-cells to the video game character Pac-Man. But while there’s only one gobbler of tiny dots in the game, the altered T-cells proliferate throughout the body.
That’s what can lead to damaging side effects, said Dr. Aaron Rapoport, a Maryland oncologist who helped pioneer T-cell immunotherapy for blood cancers.
When the CAR-T cells start attacking the lymphoma, other immune cells “get in the act” and cause a “robust reaction” in which chemical mediators are released in high levels, he said. Because CAR-T cells are multiplying, the chemical reactions associated with the process can lead to fever, unstable blood pressure and toxic issues. That’s what can cause organ failure, which can be reversed, or neurological damage, which can’t.
On May 7, 2018, Gary became the fourth person at the Maryland center to get the treatment. Putting the altered T-cells back into his body was the easy part; the infusion lasted about 15 minutes.
Teresa and the CAR-T coordinator at the hospital wrapped their arms around each other and cried, certain this would be the treatment that finally worked.
‘HE’S DONE WELL’
About 15 doctors monitored Gary’s progress, ready to admit him into intensive care, but he didn’t need it. His reaction was “mild to moderate,” Rapoport said, as fluid built up in Gary’s lungs and around his heart. It was drained, and Gary suffered no long-term damage.
“Thankfully, he’s done well,” Rapoport said. “It’s enormously gratifying to see patients like him who didn’t have other treatment options and … to see the benefit, the impact on his life and family and on his community at large, given his strong desire to use his experience to help and support others.”
The Gardiners work with Kite Pharma, which develops immunotherapy treatments, to arrange speeches at conferences or meetings with prospective patients. Because the treatment is so rare, it’s helpful to hear “directly from people who have received it,” said Nathan Kaiser in Kite’s public affairs.
Gary said he’s thrilled to have been part of something so revolutionary that it may change the course of cancer treatment.
“It’s like sci-fi, it really is,” he said. “I feel really lucky that it was available, that I was eligible, that our insurance covered it and that my body reacted the way it did. We had everything on our side.”