Multiple Myeloma Patient Shines Bright as CAR T-Cell Therapy Outpatient 

As a systems operator who works to help maintain the electrical grid for New York state, Brian Houlihan, 46, is used to getting power to the people. But when the multiple myeloma he has lived with since 2011 stopped responding to chemotherapy, it was Houlihan who needed a recharge. 

He got it, through an innovative treatment that has slowed the abnormal, cancer-causing plasma cells in his bone marrow and jump-started his life.  

In the spring of 2023, Houlihan traveled from his home in Albany, N.Y., to Boston and became the first multiple myeloma patient at Dana-Farber Brigham Cancer Center to receive outpatient CAR T-cell therapy for the disease. After a successful recovery, and with his cancer now undetectable, he plans to return to work this winter while continuing treatment in the Albany area.  

“I was not worried, because I had a lot of faith and confidence in my care team. ” says Houlihan of his status as CAR-T outpatient pioneer. “They took great care of me, and I’m feeling better all the time.” 

CAR T-cell therapy is used to treat various blood cancers. To date, the treatment required a lengthy hospital stay, but increased understanding and refinement of the CAR T process and experience managing its side effects has enabled Dana-Farber Brigham to begin offering it as an outpatient procedure. Daily in-person checkups are still required for several weeks after an individual’s T cells are reinfused, but patients can spend their nights at home or in other housing near the cancer center’s Boston campus. A caregiver — in Houlihan’s case, his wife Kristi — is also required to help monitor their daily symptoms. 

Sore back to stem cells 

The journey that led to Houlihan’s pioneering CAR T role started in the winter of 2011, when severe back pain landed him in an Albany-area emergency room. Although X-rays initially showed no problems, and he was sent home that night, the pain persisted. 

“I couldn’t raise my arm without my back hurting,” says Houlihan. “Even sitting in one place for a long time hurt, so I had an MRI done at a spine and joint center. The doctor there had no idea what it was.” 

That doctor contacted a local oncologist, who ran more tests that confirmed the cause of Houlihan’s back pain: multiple myeloma. The oncologist wanted Houlihan, then 34, to get a second opinion right away at a cancer center specializing in the disease, and referred him to Dana-Farber Brigham. In late April, Houlihan and his wife drove to Boston and met with Jacob Laubach, MD, MPP, chief of the Division of Plasma Cell Neoplasias at Dana-Farber Cancer Institute and clinical director of its Jerome Lipper Multiple Myeloma Program.    

“Dr. Laubach was great, and gave me faith that we were going to be able to get things under control.” recalls Houlihan. “He started me on a chemotherapy regimen that I could do locally near my home in Albany, twice a week for 12 weeks, and he checked in regularly with my doctor there.” 

At the time, Laubach and Houlihan also discussed the likelihood of his getting a stem cell transplant as part of his treatment. Although multiple myeloma is not curable, many patients can lead long, active lives with relatively few symptoms. Those who are medically suitable usually receive stem cell transplants after four to eight months of induction chemotherapy, and Houlihan returned to Boston to have his on Sept. 15, 2011. He and Kristi have referred to that day ever since as his “second birthday.” 

After his very successful stem cell transplant, Houlihan was on a maintenance treatment for nearly a decade which consisted of daily oral chemotherapy (three weeks on, one week off) and periodic check-ins with his care teams in Albany and Boston. He describes this period as “smooth sailing” during which he worked and enjoyed life with Kristi and their three children. His multiple myeloma remained at an undetectable level. 

Another fresh start 

Then, in 2020, came a pair of challenges. In March, when the COVID-19 pandemic hit the United States, Houlihan was sequestered at his job site for two months due to his status as an essential worker on New York’s electrical grid. Then, just after returning to his family, he began experiencing back pain similar to that which preceded his original diagnosis.  

Tests confirmed the multiple myeloma was growing again, and Houlihan began a series of chemotherapy protocols under Laubach’s care. Each proved less effective than the last, and in spring 2023 Laubach proposed CAR T-cell therapy.  

“I felt that at this point, CAR T-cell treatment would provide Mr. Houlihan the best opportunity to have achieve lasting response to treatment,” says Laubach. “Our program had planned extensively and taken many steps to ensure the CAR-T product could be administered safely in the outpatient setting. Mr. Houlihan was a trailblazer as the first individual with multiple myeloma to receive product in this manner.” 

Taking a leave from work, Houlihan relocated to Boston — and with the help of the company manufacturing his CAR T cells, found a discounted hotel to stay in throughout the process. He underwent intensive chemotherapy for three days to make room in his immune system for his T cell reinfusion. Then, after receiving his CAR T cells, he had a month-plus of daily monitoring in the outpatient clinic by Laubach and his team — as well as by Kristi back at their hotel — punctuated by several hospitalizations for management of side-effects including prolonged low blood counts related to his CAR-T procedure. 

“I checked Brian’s blood pressure, oxygen level, temperature, and heart rate daily and reported them back to the care team, and also asked him a series of cognitive questions to make sure all was OK on that end,” Kristi recalls of this period. “It was nice to feel I was helping she was helping and to have him with me most nights instead of having to stay at the hospital, waiting for something to happen.”  

Houlihan agrees, and credits other loved ones for making it possible. 

“My mother-in-law Maureen came up to New York from South Carolina to take care of our 10-year-old son, Chase, while he finished the school year, took him home with her for three weeks, and then came back up to help again when I was hospitalized later on for side effects,” says Houlihan. “My stepdaughter Maddie and her boyfriend put us at ease by continuing to take care of Chase while we were in Boston, and Kristi kept an online diary to keep the family up on my progress. You realize just how much someone loves you when they help you through something like this; I couldn’t have done it without all of them.” 

 Now that he’s back home, and almost back to work, Houlihan can reflect on the challenges he’s been through — and the knowledge that it was all worth it. 

“The side effects were tough, and I still need to get infusions of red blood cells and platelets every week,” says Houlihan. “But I’m really happy knowing that I have no detectable disease; that’s what I was looking forward to hearing. CAR-T was definitely my best option.”