1
00:00:01,000 --> 00:00:06,500
Cancer. It may be years before we
solve the problem. Yet, already,

2
00:00:06,500 --> 00:00:09,680
we're quite sure that we'll get there.

3
00:00:09,680 --> 00:00:11,920
In fact, we can say with certainty
that one day

4
00:00:11,920 --> 00:00:13,560
cancer will be controlled.

5
00:00:30,600 --> 00:00:33,840
My mum did worry that I spent too
much time messing

6
00:00:33,840 --> 00:00:35,960
around with computers and things
and not enough time

7
00:00:35,960 --> 00:00:37,480
talking to people.

8
00:00:43,640 --> 00:00:45,600
As a child, the things that I
enjoyed most

9
00:00:45,600 --> 00:00:46,840
was taking apart old radios

10
00:00:46,840 --> 00:00:49,280
or bits of electronics and trying
to figure out how they worked

11
00:00:49,280 --> 00:00:51,080
and make them do things
that they otherwise

12
00:00:51,080 --> 00:00:53,120
wouldn't normally do.

13
00:00:53,120 --> 00:00:56,120
I suppose, the pleasure of a robot
builder.

14
00:00:56,120 --> 00:00:58,840
Early suspicion, accurate diagnosis

15
00:00:58,840 --> 00:01:01,480
and effective treatment have brought
about marked

16
00:01:01,480 --> 00:01:03,280
reductions in mortality.

17
00:01:04,520 --> 00:01:07,840
Our knowledge of cancer has grown
tremendously in recent years.

18
00:01:07,840 --> 00:01:09,880
Do you know I'm making some
porridge?

19
00:01:10,920 --> 00:01:13,520
Egg sandwich? Cereal?
You want cereal? Go on.

20
00:01:16,360 --> 00:01:19,280
Eventually, I ended up in medical
school.

21
00:01:19,280 --> 00:01:21,600
I got really fascinated by
haematology.

22
00:01:21,600 --> 00:01:23,120
Come on, let's go.

23
00:01:23,120 --> 00:01:24,360
Come on, come on, come on!

24
00:01:26,800 --> 00:01:29,280
The really nice thing about blood is
that you can look at it

25
00:01:29,280 --> 00:01:31,400
under the microscope.

26
00:01:31,400 --> 00:01:33,560
It's very, very tangible.

27
00:01:33,560 --> 00:01:36,600
It suddenly felt very,
very familiar.

28
00:01:36,600 --> 00:01:40,120
Actually, these cells were machines.

29
00:01:40,120 --> 00:01:42,880
Like radios
that you might take apart.

30
00:01:44,320 --> 00:01:47,160
And, actually, the genetic code is
not really that dissimilar

31
00:01:47,160 --> 00:01:48,720
to a computer program.

32
00:01:53,640 --> 00:01:56,280
You're working on one of the most
exciting treatments for cancer

33
00:01:56,280 --> 00:01:58,320
in the world right now.

34
00:01:58,320 --> 00:02:00,440
What is the aim
of the research you do?

35
00:02:00,440 --> 00:02:02,920
Ultimately, what we want to do
is to try and cure all cancers.

36
00:02:04,440 --> 00:02:07,720
A lot of the technology that makes
it possible has been developed

37
00:02:07,720 --> 00:02:10,600
but ultimately we depend
on the patients entering

38
00:02:10,600 --> 00:02:11,960
our experimental trials.

39
00:02:19,840 --> 00:02:21,160
And there's the man!

40
00:02:22,160 --> 00:02:25,080
It's only when you do the clinical
studies that you really know what's

41
00:02:25,080 --> 00:02:28,400
going to work and why something
doesn't work.

42
00:02:42,400 --> 00:02:43,840
We're amazingly close.

43
00:02:59,680 --> 00:03:00,880
VOICE RECORDER BEEPS

44
00:03:00,880 --> 00:03:03,520
Graham Threader, hospital number
four, one, two, one, six,

45
00:03:03,520 --> 00:03:05,120
three, four, eight.

46
00:03:10,320 --> 00:03:13,800
Graham Threader is a 52-year-old
gentleman who has been referred

47
00:03:13,800 --> 00:03:17,360
to immunotherapy clinic for
consideration of Car T-Cell Therapy.

48
00:03:17,360 --> 00:03:19,360
Full stop. New paragraph.

49
00:03:23,640 --> 00:03:26,280
He was originally diagnosed in
August 2015

50
00:03:26,280 --> 00:03:28,120
following a collapse at home...

51
00:03:29,760 --> 00:03:32,560
..and was found to have leukaemia at
that time, full stop.

52
00:03:38,560 --> 00:03:41,520
If you're a patient who's had acute
lymphoblastic leukaemia,

53
00:03:41,520 --> 00:03:43,680
the chances are you've been through
multiple rounds

54
00:03:43,680 --> 00:03:45,360
of very intense chemotherapy.

55
00:03:50,160 --> 00:03:52,520
You can't possibly work during that
time so, you know,

56
00:03:52,520 --> 00:03:54,200
you have to leave your job.

57
00:03:54,200 --> 00:03:56,320
It has huge effects on your family

58
00:03:56,320 --> 00:03:59,120
and on everything else,
so it's really very nice for us

59
00:03:59,120 --> 00:04:02,520
in medical science to imagine a time
when, actually, you can get rid

60
00:04:02,520 --> 00:04:05,280
of all the really horrible,
intensive treatments

61
00:04:05,280 --> 00:04:08,920
and replace them with something that
is, you know, for want of a better

62
00:04:08,920 --> 00:04:10,160
word, more natural.

63
00:04:10,160 --> 00:04:14,040
It's a new way of targeting
the leukaemia's lymphomas...

64
00:04:14,040 --> 00:04:16,120
You know, and we think it certainly
holds

65
00:04:16,120 --> 00:04:18,080
some promise over, you know,
the standard

66
00:04:18,080 --> 00:04:20,280
kind of chemotherapies.

67
00:04:20,280 --> 00:04:23,560
This is obviously your... My
brother. Your bro. Yeah. OK.

68
00:04:23,560 --> 00:04:25,440
The donor of the moment!

69
00:04:25,440 --> 00:04:28,320
You will get hooked up to the
machine.

70
00:04:28,320 --> 00:04:32,320
You know, we collect from you these
immune cells.

71
00:04:32,320 --> 00:04:34,520
We genetically engineer them

72
00:04:34,520 --> 00:04:36,160
so they target cancer.

73
00:04:36,160 --> 00:04:37,280
I mean, I guess...

74
00:04:37,280 --> 00:04:39,240
So, my understanding is that you
basically...

75
00:04:39,240 --> 00:04:41,440
We take Andy's cells,
we weaponise them,

76
00:04:41,440 --> 00:04:43,400
we put them in me and they get to
work. Yeah.

77
00:04:43,400 --> 00:04:45,360
So, that is the idea.
That is the idea.

78
00:04:45,360 --> 00:04:48,960
So, you have your cells and then we
watch you. Right?

79
00:04:48,960 --> 00:04:50,200
And that is it.

80
00:04:50,200 --> 00:04:52,840
And why are we so worried? And
why do we want to keep you in?

81
00:04:52,840 --> 00:04:55,680
Well, actually, these cells...
I'm sure you've probably looked

82
00:04:55,680 --> 00:04:58,680
on the internet, you've probably
seen there are some toxicities.

83
00:04:58,680 --> 00:04:59,920
Right?

84
00:05:01,240 --> 00:05:04,200
There's two things that we worry
about in the immediate aftermath

85
00:05:04,200 --> 00:05:06,640
of the cell infusion.

86
00:05:06,640 --> 00:05:10,000
The first thing is something called
cytokine release syndrome.

87
00:05:10,000 --> 00:05:11,480
OK?

88
00:05:11,480 --> 00:05:13,400
Basically, you talk about flu.

89
00:05:13,400 --> 00:05:16,200
You know, it's sort of the worst
flu you can imagine.

90
00:05:17,400 --> 00:05:20,960
The second thing is there can be
irritation of the brain

91
00:05:20,960 --> 00:05:23,080
from this treatment
and it's not fully understood.

92
00:05:23,080 --> 00:05:25,320
People don't know exactly
why it happens.

93
00:05:31,800 --> 00:05:34,440
A lot of early Car T-Cell
development has been done

94
00:05:34,440 --> 00:05:35,640
in the United States.

95
00:05:35,640 --> 00:05:38,160
NEWSREADER: ...on the news that
the company is discontinuing

96
00:05:38,160 --> 00:05:41,560
a trial of an experimental cancer
treatment known as Car T.

97
00:05:41,560 --> 00:05:45,640
So, there was one study that was run
by a biotech company called Juno,

98
00:05:45,640 --> 00:05:47,560
I guess, that was particularly
punchy.

99
00:05:47,560 --> 00:05:49,640
This trial was stopped after they
saw some deaths

100
00:05:49,640 --> 00:05:52,120
and then restarted after they
thought they'd gotten a handle

101
00:05:52,120 --> 00:05:53,960
on what had happened and then
stopped again

102
00:05:53,960 --> 00:05:56,000
after they unfortunately saw a few
more.

103
00:05:56,000 --> 00:05:57,800
Genetic transformation is what's

104
00:05:57,800 --> 00:05:59,480
causing these deaths? Or...?

105
00:05:59,480 --> 00:06:02,120
Well, first of all, this is kind of
a normal part of this process,

106
00:06:02,120 --> 00:06:05,120
which is, you know, trials typically
go through real difficulties.

107
00:06:05,120 --> 00:06:07,360
And they have seen some really
remarkable

108
00:06:07,360 --> 00:06:08,880
responses in patients.

109
00:06:10,600 --> 00:06:12,760
I've designed my own Car T cells.

110
00:06:13,960 --> 00:06:17,760
You do your best based on what
you know from previous studies.

111
00:06:17,760 --> 00:06:21,120
I'm very proud of the fact that
we've made Car T-Cell Therapy

112
00:06:21,120 --> 00:06:24,240
available. It's nice to bring this
treatment for the first time

113
00:06:24,240 --> 00:06:26,040
to the UK.

114
00:06:26,040 --> 00:06:30,360
I'm quite clear this is the only
route that's open to me

115
00:06:30,360 --> 00:06:34,080
to try and survive my leukaemia, so,
from my point of view... Yep.

116
00:06:34,080 --> 00:06:35,400
I'm not giving up yet.

117
00:06:35,400 --> 00:06:36,600
Yeah, of course, of course.

118
00:06:36,600 --> 00:06:38,040
And I want to go for it.

119
00:06:38,040 --> 00:06:41,440
One of our issues is that we've got
one lab to make these cells.

120
00:06:41,440 --> 00:06:44,120
So in terms of actually making a
product for you, we might be looking

121
00:06:44,120 --> 00:06:46,520
at the beginning of November.

122
00:06:46,520 --> 00:06:49,200
We'd be looking then
at infusion in December.

123
00:06:49,200 --> 00:06:50,360
Really? OK.

124
00:06:50,360 --> 00:06:54,280
You know, I'm on this recovery
medication at the minute. Mm-hm.

125
00:06:54,280 --> 00:06:58,880
I'm conscious that they can't,
you know... How can I put it?

126
00:06:58,880 --> 00:07:01,000
You can't keep
the plane circling forever.

127
00:07:01,000 --> 00:07:03,160
Yeah, yeah, yeah, yeah.

128
00:07:03,160 --> 00:07:08,720
The trick here is to try to keep
me alive until December. Indeed.

129
00:07:08,720 --> 00:07:10,760
Just need to be clear in my head.
Yeah.

130
00:07:10,760 --> 00:07:12,960
I've got to go back and talk
through with the family...

131
00:07:12,960 --> 00:07:14,800
Yeah, of course. ..where we're at.

132
00:07:28,200 --> 00:07:30,440
Engineering nature
is really great fun.

133
00:07:30,440 --> 00:07:33,280
I mean, it's as if somebody
is giving you this huge, big

134
00:07:33,280 --> 00:07:36,960
complicated tool kit
and you're pulling bits of it out

135
00:07:36,960 --> 00:07:40,400
and putting other bits in and then
seeing what happens.

136
00:07:40,400 --> 00:07:42,360
You know, in a way,

137
00:07:42,360 --> 00:07:46,280
biological life on Earth is kind
of an alien entity, in a way.

138
00:07:46,280 --> 00:07:48,920
I mean, you could look at it like
that. You could look at evolution

139
00:07:48,920 --> 00:07:51,960
as being, sort of, er,
an alien intelligence.

140
00:07:54,160 --> 00:07:56,880
All these billions of permutations
over time as a sort of

141
00:07:56,880 --> 00:07:59,720
a biological computer crunching
away trying to find solutions

142
00:07:59,720 --> 00:08:02,720
to signalling problems.

143
00:08:02,720 --> 00:08:04,600
Problems that cells need to solve.

144
00:08:04,600 --> 00:08:07,600
So, in a way, this computer has been
running for hundreds

145
00:08:07,600 --> 00:08:09,440
of millions and billions of years.

146
00:08:09,440 --> 00:08:11,080
And here it is.

147
00:08:11,080 --> 00:08:13,720
And we're just taking what she's
done and trying to make

148
00:08:13,720 --> 00:08:15,120
it a little bit better.

149
00:08:35,840 --> 00:08:37,480
Obviously, we grew up together but

150
00:08:37,480 --> 00:08:38,680
this sort of thing you do

151
00:08:38,680 --> 00:08:41,120
for anybody, really, if it's, erm...

152
00:08:42,240 --> 00:08:43,760
..if what you've got is compatible

153
00:08:43,760 --> 00:08:45,200
and that's what they need

154
00:08:45,200 --> 00:08:48,040
I don't think it's
much of an ask, really.

155
00:08:48,040 --> 00:08:50,160
I'm very positive and my mind's
saying,

156
00:08:50,160 --> 00:08:53,360
"Yes, it's going to be good,"
although mine's the easy part!

157
00:08:53,360 --> 00:08:55,960
Mine's taken out, so it doesn't
really change my body at all.

158
00:09:12,520 --> 00:09:14,440
Like every other...

159
00:09:15,720 --> 00:09:18,520
..cancer patient I've ever met,

160
00:09:18,520 --> 00:09:21,560
you will fight to cling on
to being alive.

161
00:09:22,760 --> 00:09:24,080
And you won't let go easily.

162
00:09:24,080 --> 00:09:26,280
So for me,

163
00:09:26,280 --> 00:09:28,880
the risk of doing nothing
is that I die.

164
00:09:28,880 --> 00:09:30,320
Simple as.

165
00:09:32,120 --> 00:09:34,720
Do the trial and, you know,
it could be brilliant.

166
00:09:37,120 --> 00:09:38,840
Or it could kill me.

167
00:09:40,680 --> 00:09:43,440
The reason it's called a "trial"
is because they don't have huge

168
00:09:43,440 --> 00:09:47,200
amounts of data and you only get
that from doing a trial.

169
00:09:47,200 --> 00:09:49,800
Someone's got to go first, right?

170
00:09:49,800 --> 00:09:51,440
Otherwise nothing gets done!

171
00:09:54,880 --> 00:09:57,920
At UCL at the moment we're running
two trials for leukaemia.

172
00:09:58,920 --> 00:10:02,560
One of them is called the Card study
and that's the one that Graham's on.

173
00:10:04,960 --> 00:10:09,320
The trial in total will be
between 12 and 14 patients.

174
00:10:10,880 --> 00:10:13,280
The patients are very much
in isolation

175
00:10:13,280 --> 00:10:16,000
and not really aware of each
other's treatments.

176
00:10:18,240 --> 00:10:21,880
What's Graham's illness done
to your relationship?

177
00:10:21,880 --> 00:10:23,520
Has it changed things at all?

178
00:10:23,520 --> 00:10:27,280
Um, I feel very protective.

179
00:10:28,800 --> 00:10:31,840
But you don't need protecting,
really, do you?

180
00:10:31,840 --> 00:10:35,280
He's like, invincible - just goes
out and does he what wants to do.

181
00:10:35,280 --> 00:10:37,520
I don't think I do that.

182
00:10:37,520 --> 00:10:40,880
Well, sometimes you do.
In my... In my mind,

183
00:10:40,880 --> 00:10:43,240
you do things I'd rather
you didn't do.

184
00:10:43,240 --> 00:10:47,680
I don't want to be stuffed in an
armchair with a blanket over my lap.

185
00:10:47,680 --> 00:10:50,880
I just want you just to take
a bit of time out,

186
00:10:50,880 --> 00:10:53,640
so I think you need to have one
of those this afternoon.

187
00:10:53,640 --> 00:10:55,280
Yeah, maybe.

188
00:10:55,280 --> 00:10:57,440
Yeah, maybe. See, this is it.

189
00:10:57,440 --> 00:10:58,840
Maybe and then you won't do it,

190
00:10:58,840 --> 00:11:01,880
and then you'll carry on all day,
we'll go out this evening

191
00:11:01,880 --> 00:11:04,080
and tomorrow you'll just
feel terrible.

192
00:11:21,040 --> 00:11:23,360
People keep saying, what are
you doing for Christmas?

193
00:11:23,360 --> 00:11:25,680
I'm thinking I can't think
past the end of next Friday

194
00:11:25,680 --> 00:11:27,760
and I'm quite happy that way,
to be honest.

195
00:11:27,760 --> 00:11:30,560
But I have bought him -
I'll have to show it to you -

196
00:11:30,560 --> 00:11:34,080
I've bought him a special
Christmas tree decoration.

197
00:11:34,080 --> 00:11:36,640
It's a guinea pig!

198
00:11:37,880 --> 00:11:39,680
With a Santa hat on it.

199
00:11:42,640 --> 00:11:46,800
Do you see the patients taking part
in this trial like guinea pigs?

200
00:11:46,800 --> 00:11:51,560
Yeah, I do, because it's
not been done before...

201
00:11:51,560 --> 00:11:54,800
..in this country...

202
00:11:54,800 --> 00:11:57,920
..on patients of Graham's
age with Graham's cancer.

203
00:12:00,200 --> 00:12:01,360
Sounds great.

204
00:12:01,360 --> 00:12:03,680
Just wish I could ride it.

205
00:12:03,680 --> 00:12:07,920
First thing I'm going to do when
I'm strong enough is take this out.

206
00:12:07,920 --> 00:12:10,720
It's not the same running it in a
garage for five minutes.

207
00:12:10,720 --> 00:12:12,400
Keep the battery on charge.

208
00:12:16,680 --> 00:12:21,880
It's a massive step forward but it
comes with a complete unknown.

209
00:12:28,040 --> 00:12:30,800
I don't really know
how he's feeling.

210
00:12:35,960 --> 00:12:38,600
I think he's just feeling...

211
00:12:38,600 --> 00:12:42,280
No, it's just, because he doesn't
want to start going downhill.

212
00:12:42,280 --> 00:12:44,960
He wants to just get in
and get in...

213
00:12:44,960 --> 00:12:47,440
Get in the ring and fight it.

214
00:12:47,440 --> 00:12:50,400
And if I'm fit enough to do that,
then I'm all right

215
00:12:50,400 --> 00:12:52,080
for Tony's stag weekend.

216
00:12:52,080 --> 00:12:53,600
Yeah.

217
00:12:53,600 --> 00:12:56,680
I mean, he's already talking
about going skiing.

218
00:12:56,680 --> 00:13:00,320
Do this with the rugby boys and
this with his friends from school,

219
00:13:00,320 --> 00:13:03,880
and in my mind, I'm thinking,
you've got to be kidding.

220
00:13:03,880 --> 00:13:07,840
And then in my mind I'm also
thinking, yeah - go, you.

221
00:13:11,240 --> 00:13:13,720
Let me demonstrate
how Car T-Cell works.

222
00:13:20,040 --> 00:13:24,200
Well, actually, that's a pretty
good prop for a cancer cell.

223
00:13:25,520 --> 00:13:27,120
You can use these.

224
00:13:27,120 --> 00:13:29,760
Here we go.

225
00:13:29,760 --> 00:13:31,720
Perfect.

226
00:13:31,720 --> 00:13:33,840
Ping-pong balls.

227
00:13:33,840 --> 00:13:37,200
OK, so this is a T cell
and it's one of the main bits

228
00:13:37,200 --> 00:13:39,320
of our immune system
that hunts down cells

229
00:13:39,320 --> 00:13:41,160
that are infected with viruses.

230
00:13:41,160 --> 00:13:43,800
That's its main job, is to move
around the body looking for any cell

231
00:13:43,800 --> 00:13:45,240
that's infected with a virus.

232
00:13:45,240 --> 00:13:48,280
When it finds a cell that's infected
with a virus, it kills it.

233
00:13:48,280 --> 00:13:51,320
These are two normal cells here
and this is a cancer cell.

234
00:13:51,320 --> 00:13:54,560
So the T cell's coming around,
it's examining these cells.

235
00:13:54,560 --> 00:13:57,400
It's fine so it moves on, and then
it examines this cancer cell,

236
00:13:57,400 --> 00:13:59,520
and actually, it's not going
to react to it,

237
00:13:59,520 --> 00:14:02,080
because the cancer cell
has come from a normal cell.

238
00:14:02,080 --> 00:14:03,920
So as far as this T cell
is concerned,

239
00:14:03,920 --> 00:14:05,720
it's just part of our body,

240
00:14:05,720 --> 00:14:07,360
so then it moves on.

241
00:14:07,360 --> 00:14:10,280
So what we do in Car T-Cell therapy,
we take a T cell like this

242
00:14:10,280 --> 00:14:13,360
and we take it out of the patient's
body in their blood

243
00:14:13,360 --> 00:14:16,080
and then we take it to a special
very clean laboratory

244
00:14:16,080 --> 00:14:17,880
where we can make cellular therapies

245
00:14:17,880 --> 00:14:20,760
and what we need to do is we
need to reprogram this T cell

246
00:14:20,760 --> 00:14:23,000
to do what we want it to do,
and how we reprogram it

247
00:14:23,000 --> 00:14:24,840
is using something called a vector.

248
00:14:24,840 --> 00:14:27,040
And I've got a vector here,
a USB key,

249
00:14:27,040 --> 00:14:30,720
so what a vector is essentially
is a modified virus,

250
00:14:30,720 --> 00:14:35,400
and what we use the vector to do
is to plug in a new piece of DNA

251
00:14:35,400 --> 00:14:37,280
into the T cell,
and a new piece of DNA

252
00:14:37,280 --> 00:14:39,360
contains a new computer program

253
00:14:39,360 --> 00:14:42,040
and tells this T cell
to behave differently.

254
00:14:42,040 --> 00:14:44,920
In this case, to make a
new protein on its surface

255
00:14:44,920 --> 00:14:46,880
and then it becomes - hey, presto -
a Car T-Cell.

256
00:14:46,880 --> 00:14:49,400
We inject this back into the patient

257
00:14:49,400 --> 00:14:52,040
and again it does
what it normally does.

258
00:14:52,040 --> 00:14:54,480
Going around looking at cells,
and this time when it comes

259
00:14:54,480 --> 00:14:56,520
to the cancer cell,
it doesn't ignore it any more,

260
00:14:56,520 --> 00:14:59,240
because we've reprogrammed it,
so now it's going to recognise

261
00:14:59,240 --> 00:15:01,320
this cancer cell and it's
actually going to kill it.

262
00:15:01,320 --> 00:15:04,400
And then what this T cell does is,
after it's killed the cancer cell,

263
00:15:04,400 --> 00:15:07,680
it can actually make copies of
itself and then it moves around

264
00:15:07,680 --> 00:15:10,400
and keeps on going looking
for other tumour cells.

265
00:15:10,400 --> 00:15:13,640
So that's Car T-Cell therapy
in a nutshell.

266
00:15:31,040 --> 00:15:34,480
Mahmoud, he's on a different
trial to Graham.

267
00:15:35,920 --> 00:15:38,320
He's the first patient on this study

268
00:15:38,320 --> 00:15:41,840
and he's the youngest patient
we would recruit.

269
00:15:41,840 --> 00:15:46,280
OK, so that's going to be your line
that goes out.

270
00:15:48,440 --> 00:15:50,040
You might feel a little bit dizzy.

271
00:15:50,040 --> 00:15:52,000
The blood pressure
can sometimes change

272
00:15:52,000 --> 00:15:55,080
just because we're taking blood
out of your system, you know,

273
00:15:55,080 --> 00:15:56,240
and replacing it.

274
00:15:57,600 --> 00:16:01,760
On this trial, we actually
use his cells to manufacture

275
00:16:01,760 --> 00:16:04,600
the Car T, so we're not involving
a donor.

276
00:16:06,200 --> 00:16:09,440
What do you know about what's
happening to you today?

277
00:16:09,440 --> 00:16:14,280
Well, the machine is taking
my blood.

278
00:16:14,280 --> 00:16:17,320
The white blood cells,
they're collecting it

279
00:16:17,320 --> 00:16:19,280
so that they can modify them.

280
00:16:20,520 --> 00:16:25,200
Change the white blood cells
so that they can put them back

281
00:16:25,200 --> 00:16:29,960
into me and then hopefully
they will attack my leukaemia cells

282
00:16:29,960 --> 00:16:32,200
if they're detected.

283
00:16:32,200 --> 00:16:34,640
And that will cure my cancer.

284
00:16:38,480 --> 00:16:42,880
I first met Mahmoud when he was
having salvage treatment for relapse

285
00:16:42,880 --> 00:16:45,680
of his leukaemia.

286
00:16:45,680 --> 00:16:48,640
He then went on and had
a bone marrow transplant.

287
00:16:48,640 --> 00:16:53,520
Unfortunately, he then went on
to relapse post the transplant.

288
00:16:55,960 --> 00:16:59,920
His outlook - without treatment,
he would deteriorate within weeks.

289
00:17:02,040 --> 00:17:06,640
This is the best way to get him
a shot of having a long-term cure.

290
00:17:07,760 --> 00:17:11,800
Can I have work sent
from maths, physics

291
00:17:11,800 --> 00:17:14,040
and BTEC business?

292
00:17:17,520 --> 00:17:21,560
Maybe when I come back to school,
you could organise a party.

293
00:17:21,560 --> 00:17:22,800
Return party.

294
00:17:24,880 --> 00:17:26,160
OK, thank you, bye.

295
00:17:28,640 --> 00:17:33,240
I've always hated going to secondary
school but I miss school now.

296
00:17:33,240 --> 00:17:35,360
Miss it a lot.

297
00:17:35,360 --> 00:17:37,400
And what are you
doing with your time

298
00:17:37,400 --> 00:17:39,640
at the moment if you're
not at school?

299
00:17:39,640 --> 00:17:41,440
On my laptop playing games

300
00:17:41,440 --> 00:17:45,000
or my Xbox playing games
or watching YouTube.

301
00:17:46,960 --> 00:17:49,960
I'm not allowed outside
because of my immune system.

302
00:17:49,960 --> 00:17:52,600
I'm not usually this weak.

303
00:17:52,600 --> 00:17:56,080
Very athletic, energetic person.

304
00:17:56,080 --> 00:17:59,040
Not in the morning,
but throughout the day.

305
00:18:02,320 --> 00:18:06,240
If this treatment works -
and I'm begging it will -

306
00:18:06,240 --> 00:18:08,480
go back to normal life.

307
00:18:08,480 --> 00:18:11,120
Just live, I guess.

308
00:18:11,120 --> 00:18:12,520
Just want to live.

309
00:18:16,600 --> 00:18:19,640
I guess there are bad thoughts
that it won't work.

310
00:18:21,200 --> 00:18:23,720
Be heartbreaking for my mum, cos...

311
00:18:25,720 --> 00:18:28,600
..I feel like it's my last hope.

312
00:18:28,600 --> 00:18:33,000
My doctor, Dr Carpenter,
has been very supportive.

313
00:18:34,280 --> 00:18:35,520
Do you trust them? Yep.

314
00:18:37,320 --> 00:18:38,720
Who else can I trust?

315
00:18:49,880 --> 00:18:53,960
There are time lags
in manufacturing these products.

316
00:18:55,600 --> 00:18:58,840
One of the biggest worries
with Graham is keeping him alive

317
00:18:58,840 --> 00:19:02,160
whilst we wait for the lab to
manufacture his brother's cells.

318
00:19:04,320 --> 00:19:07,400
We're using a drug called Dasatinib.

319
00:19:08,720 --> 00:19:11,440
But his disease is very aggressive.

320
00:19:15,200 --> 00:19:17,520
At the moment it seems
to be working,

321
00:19:17,520 --> 00:19:20,640
but I'd need to see what's happening
in his bone marrow.

322
00:19:20,640 --> 00:19:24,360
What's happening, you know,
effectively at the site of disease.

323
00:19:28,760 --> 00:19:32,400
A bone marrow investigation gives us
the most accurate read

324
00:19:32,400 --> 00:19:35,120
of degree of disease
down to a molecular level.

325
00:19:37,960 --> 00:19:41,560
OK, so just going to pop some
anaesthetic under the skin.

326
00:19:41,560 --> 00:19:43,520
Is that sharp?

327
00:19:43,520 --> 00:19:44,880
Ah! Sorry.

328
00:19:51,080 --> 00:19:54,280
All right. This bit is going
to be painful, OK?

329
00:19:56,120 --> 00:19:57,240
OK?

330
00:20:24,720 --> 00:20:27,800
The leukaemia cells are advancing
and overwhelming

331
00:20:27,800 --> 00:20:30,680
all the normal blood cells.

332
00:20:30,680 --> 00:20:32,880
It's a biological battle,
it's ongoing.

333
00:20:36,680 --> 00:20:41,640
I'm just going to check the sample,
OK? You've done really, really well.

334
00:20:41,640 --> 00:20:43,440
How was that?

335
00:20:43,440 --> 00:20:45,080
Huh!

336
00:20:45,080 --> 00:20:47,560
Don't take this the wrong way,
but I don't recommend.

337
00:20:47,560 --> 00:20:50,760
It's just the whole thing's
just not a fun day out. No.

338
00:21:01,400 --> 00:21:02,760
Hey, guys!

339
00:21:02,760 --> 00:21:06,600
MUSIC: September
by Earth, Wind and Fire

340
00:21:12,480 --> 00:21:14,520
This is what I have to put up with.

341
00:21:15,800 --> 00:21:18,160
Where are you going tomorrow?
Margate.

342
00:21:25,400 --> 00:21:28,160
We're going to have a little
holiday. For a day.

343
00:21:31,200 --> 00:21:33,400
Look down there at the sign.

344
00:21:33,400 --> 00:21:34,640
"First aid."

345
00:21:34,640 --> 00:21:37,200
Yeah, that might be your
saving grace.

346
00:21:37,200 --> 00:21:39,720
Shall we go right, then?

347
00:21:46,040 --> 00:21:51,800
Found a shell. If I put this to my
ear, I can hear the sea in it.

348
00:21:51,800 --> 00:21:55,960
And if I take it away again,
I can still hear the sea.

349
00:21:55,960 --> 00:21:57,800
How does that work, then?

350
00:21:57,800 --> 00:22:00,000
You're just not funny any more.

351
00:22:00,000 --> 00:22:01,560
LAUGHTER

352
00:22:07,360 --> 00:22:09,160
Why is your back bad?

353
00:22:11,480 --> 00:22:13,040
Don't know.

354
00:22:14,360 --> 00:22:15,680
Mum, any guesses?

355
00:22:17,080 --> 00:22:19,320
Tiles.

356
00:22:19,320 --> 00:22:24,600
Tiles that went upstairs
in a big box carried by

357
00:22:24,600 --> 00:22:28,080
somebody who shouldn't have
been carrying them.

358
00:22:47,760 --> 00:22:51,680
Unfortunately, the Dasatinib
stopped working.

359
00:22:53,160 --> 00:22:56,080
The leukaemia cells
have outsmarted the drug.

360
00:22:58,040 --> 00:23:00,760
They've come back and they've
completely occupied

361
00:23:00,760 --> 00:23:01,800
the entire marrow.

362
00:23:03,480 --> 00:23:07,200
You get a lot of this stabbing
pain in all your bones,

363
00:23:07,200 --> 00:23:09,720
and your big bones
and your shoulders

364
00:23:09,720 --> 00:23:12,840
and your hips and your spine
and your ribs

365
00:23:12,840 --> 00:23:14,360
and your legs.

366
00:23:14,360 --> 00:23:19,880
Anywhere that produces bone marrow
was really kicking off big time.

367
00:23:21,600 --> 00:23:24,640
He actually thought he was going
to die in the night.

368
00:23:24,640 --> 00:23:28,200
And the bit that was bugging him
about that was he wasn't prepared

369
00:23:28,200 --> 00:23:30,240
to die until he'd given it a go,

370
00:23:30,240 --> 00:23:33,680
until he'd done the trial
and then at least he could go out

371
00:23:33,680 --> 00:23:35,440
knowing that he did it.

372
00:23:38,760 --> 00:23:43,440
The fact is your brother's cells
behaved really well in the lab.

373
00:23:43,440 --> 00:23:46,800
They've got three doses
to be able to give you.

374
00:23:46,800 --> 00:23:48,080
It's here in the hospital

375
00:23:48,080 --> 00:23:51,520
and as soon as we're given the nod
we can get started with that.

376
00:23:51,520 --> 00:23:54,800
We've got to pull out everything
that we have available to us.

377
00:23:54,800 --> 00:23:56,640
We'll have to use steroids,

378
00:23:56,640 --> 00:23:59,400
we'll have to use chemotherapy...

379
00:23:59,400 --> 00:24:01,120
..in as much as he can tolerate,

380
00:24:01,120 --> 00:24:03,480
to try to suppress things,
control things,

381
00:24:03,480 --> 00:24:05,000
to get him to the start line.

382
00:24:14,200 --> 00:24:15,520
It's weird.

383
00:24:16,560 --> 00:24:19,080
Your body, it just tells you stuff.

384
00:24:22,640 --> 00:24:26,480
I had this mad thing
in my head a week before.

385
00:24:26,480 --> 00:24:30,360
For some reason, I just had to get
these letters done

386
00:24:30,360 --> 00:24:34,680
for Mellie and the kids. Don't ask
me why, I just had this thing.

387
00:24:34,680 --> 00:24:37,640
I just need to do that
and I'd done it a while ago

388
00:24:37,640 --> 00:24:39,480
but I needed to do it again.

389
00:24:39,480 --> 00:24:44,400
I can't describe to you
what drove me to do it,

390
00:24:44,400 --> 00:24:49,120
but something inside me knew
that it was all going tits.

391
00:24:51,320 --> 00:24:53,320
I'm very lucky.

392
00:24:53,320 --> 00:24:57,760
My kids can open these letters and
know how much I really love them.

393
00:24:59,480 --> 00:25:02,600
It's in the file called
"just in case".

394
00:25:02,600 --> 00:25:04,880
Hopefully they won't be
reading that for a long time.

395
00:25:07,800 --> 00:25:10,360
This is why this thing
is so important.

396
00:25:10,360 --> 00:25:15,240
If this treatment works,
it can sidestep some other shit

397
00:25:15,240 --> 00:25:18,480
that at the minute
we will have to go through.

398
00:25:18,480 --> 00:25:20,720
Because that will be redundant.

399
00:25:20,720 --> 00:25:22,960
Big prize for this if it works.

400
00:25:31,080 --> 00:25:32,920
Turn on your side.

401
00:25:35,240 --> 00:25:38,120
Mahmoud's taken a fair beating.

402
00:25:38,120 --> 00:25:40,040
The chemo and all the infections,

403
00:25:40,040 --> 00:25:42,040
you know, it takes its toll.

404
00:25:46,840 --> 00:25:51,000
He came in today for another
blood test despite the fever.

405
00:25:51,000 --> 00:25:56,120
That has had the effect of delaying
having his Car T cells.

406
00:25:56,120 --> 00:25:59,320
It'll just be a case of trying
to find that sweet spot

407
00:25:59,320 --> 00:26:02,960
to just give the cells before things
do start to unravel.

408
00:26:05,200 --> 00:26:07,000
Mahmoud, if I leave him,

409
00:26:07,000 --> 00:26:09,280
he's very, very nervous.

410
00:26:09,280 --> 00:26:12,040
With a trial, I feel...

411
00:26:13,120 --> 00:26:15,560
..this is the only hope he has.

412
00:26:15,560 --> 00:26:16,600
I think so.

413
00:26:17,640 --> 00:26:21,480
It's something new and you want
them to do some magic.

414
00:26:24,920 --> 00:26:29,200
You have a list of questions
or things you want to go through?

415
00:26:29,200 --> 00:26:31,680
Once he's had the Car T cells,

416
00:26:31,680 --> 00:26:35,920
when will we know that something
is happening?

417
00:26:35,920 --> 00:26:40,040
Yeah. He's getting better or
it's working or it's...

418
00:26:40,040 --> 00:26:43,160
If you do get fevers and other
reactions that we think

419
00:26:43,160 --> 00:26:46,640
could be the Car T cells at work,
then that might be an early sign

420
00:26:46,640 --> 00:26:49,600
that we can see that things
are actually happening.

421
00:26:49,600 --> 00:26:51,920
Like this cytokine release syndrome,

422
00:26:51,920 --> 00:26:54,160
which you may have heard that term
already,

423
00:26:54,160 --> 00:26:56,840
but that is one of the things that
we are wary of

424
00:26:56,840 --> 00:27:00,240
because this is a treatment
after quite a lot of treatment.

425
00:27:00,240 --> 00:27:03,920
Then, you know, it is something
that can be a risk.

426
00:27:03,920 --> 00:27:05,800
A risk, yes. That's fine.

427
00:27:05,800 --> 00:27:08,000
It's not a risk. You're saving him.

428
00:27:12,040 --> 00:27:14,480
You're saving him.

429
00:27:14,480 --> 00:27:16,240
It's not a risk for Mahmoud.

430
00:27:17,680 --> 00:27:20,040
There are definitely risks involved

431
00:27:20,040 --> 00:27:23,400
but we know the risks of not doing
this are much higher.

432
00:27:33,360 --> 00:27:36,240
I mean, that's the weird
thing about all this.

433
00:27:37,440 --> 00:27:40,880
One minute you're completely
and utterly smashed

434
00:27:40,880 --> 00:27:44,320
and then they come in and say,
"Do you want to go home?"

435
00:27:44,320 --> 00:27:47,880
And I'm of course going to say,
"Absolutely, yes."

436
00:27:47,880 --> 00:27:52,600
I've probably had these from
when you were a little kid.

437
00:27:54,680 --> 00:27:57,120
Christmas is three sleeps away.

438
00:28:00,360 --> 00:28:04,280
I like Christmas a lot.
Do a bit of cooking.

439
00:28:04,280 --> 00:28:08,120
I've got my Brussels sprouts
recipe, that's nailed down.

440
00:28:08,120 --> 00:28:10,560
Drive them mad
with my favourite films -

441
00:28:10,560 --> 00:28:12,680
I always watch The Polar Express.

442
00:28:12,680 --> 00:28:15,600
Probably watching a bit of
Chitty Chitty Bang Bang, as well.

443
00:28:15,600 --> 00:28:18,560
I'll probably be doing all of that
on my own,

444
00:28:18,560 --> 00:28:21,160
although be nice
to have a bit of company.

445
00:28:21,160 --> 00:28:23,520
But kids are a bit,
"Oh, is he watching that again?

446
00:28:23,520 --> 00:28:25,760
"Every year he watches it."

447
00:28:25,760 --> 00:28:27,800
But it's Christmas.

448
00:28:28,840 --> 00:28:30,720
So this is the...

449
00:28:30,720 --> 00:28:33,080
This is the guinea pig.

450
00:28:33,080 --> 00:28:35,360
Which I just thought
was the funniest thing ever.

451
00:28:35,360 --> 00:28:37,760
I don't think he
found it quite so funny.

452
00:28:40,000 --> 00:28:43,240
What's the likelihood of finding
a guinea pig with a Santa hat on it?

453
00:28:43,240 --> 00:28:44,840
Honestly.

454
00:28:47,320 --> 00:28:49,960
Where's the guinea pig?

455
00:28:53,480 --> 00:28:56,320
Hands up who got the most presents.

456
00:28:57,680 --> 00:28:59,720
I probably did, actually.

457
00:29:02,320 --> 00:29:05,400
I've had a very lovely day, today.

458
00:29:05,400 --> 00:29:07,600
Happy Christmas.

459
00:29:24,680 --> 00:29:27,200
You would never put yourself
through this whole process

460
00:29:27,200 --> 00:29:28,960
if you didn't believe in this.

461
00:29:36,280 --> 00:29:40,120
Huge teams of people involved
in every step of the way.

462
00:29:41,160 --> 00:29:43,800
Getting agreement to host the trial,

463
00:29:43,800 --> 00:29:46,400
to develop the science
behind it all.

464
00:29:48,040 --> 00:29:52,160
Teaching medical and nursing staff
to deliver these therapies.

465
00:29:52,160 --> 00:29:56,160
Teaching the intensive care
people what they need to do.

466
00:29:57,680 --> 00:30:00,840
And all of the hoops that Graham's
had to jump through,

467
00:30:00,840 --> 00:30:03,880
we all sat here with our
fingers crossed.

468
00:30:03,880 --> 00:30:07,320
Phase one studies,
we are learning as we go.

469
00:30:07,320 --> 00:30:12,320
And, you know, you can't know it all
before you start.

470
00:30:12,320 --> 00:30:15,480
I guess that's the purpose
of the study.

471
00:30:15,480 --> 00:30:18,160
We'll have to do this every day.
Sure.

472
00:30:18,160 --> 00:30:22,960
The purpose of the test, obviously,
as you know, one of the side effects

473
00:30:22,960 --> 00:30:26,400
of the Car T cells is it can have
neurological toxicity.

474
00:30:26,400 --> 00:30:29,360
This is what we will then use
to compare

475
00:30:29,360 --> 00:30:32,920
to see if it gets any worse
after we give the cells.

476
00:30:34,160 --> 00:30:37,400
Can you count backwards
from 100 in sevens?

477
00:30:37,400 --> 00:30:40,040
93. 86.

478
00:30:40,040 --> 00:30:41,560
79.

479
00:30:43,240 --> 00:30:44,560
72.

480
00:30:44,560 --> 00:30:47,560
Can you say as many words as
possible as you can think of

481
00:30:47,560 --> 00:30:49,560
that begin with the letter F.

482
00:30:49,560 --> 00:30:51,800
Fox, fridge, fix,

483
00:30:51,800 --> 00:30:54,760
fidget, feather, fan, flower...

484
00:30:54,760 --> 00:30:57,960
Is there anything
from your perspective,

485
00:30:57,960 --> 00:31:01,520
any other worries you have or
concerns? No, it's fine.

486
00:31:01,520 --> 00:31:04,640
Looks good.

487
00:31:04,640 --> 00:31:07,080
Hello! Welcome at last.

488
00:31:07,080 --> 00:31:11,120
I'm Claire. I'm one of the doctors,
pleased to meet you.

489
00:31:11,120 --> 00:31:14,320
All right, so they'll basically
just hang the bag.

490
00:31:14,320 --> 00:31:15,800
They want to get every last
cell out

491
00:31:15,800 --> 00:31:18,960
and once they've infused, it's a
case they'll start watching you

492
00:31:18,960 --> 00:31:22,000
by the clock and taking your
temperature and blood pressure

493
00:31:22,000 --> 00:31:23,400
and all that stuff.

494
00:31:36,120 --> 00:31:39,560
Total volume is 10.32,
bag one of one.

495
00:31:48,280 --> 00:31:49,560
OK.

496
00:32:02,120 --> 00:32:04,120
Right, they're in.

497
00:32:04,120 --> 00:32:05,440
Bombs away.

498
00:32:51,280 --> 00:32:53,800
Graham has got disease on board.

499
00:32:53,800 --> 00:32:58,280
You can actually see the leukaemia
cells just by looking at his blood.

500
00:32:58,280 --> 00:33:00,200
It's mixed feelings.

501
00:33:00,200 --> 00:33:02,640
Yes, there's lots of target,

502
00:33:02,640 --> 00:33:06,360
yes, his Car T cells will get the
signals perhaps that they require

503
00:33:06,360 --> 00:33:09,600
to expand to have
an anti-tumour effect.

504
00:33:09,600 --> 00:33:14,160
But we are very aware and vigilant
for the toxic effect of the cells

505
00:33:14,160 --> 00:33:16,120
because the more disease there is,

506
00:33:16,120 --> 00:33:18,320
the more likely
there will be toxicity.

507
00:33:18,320 --> 00:33:20,120
Smile.

508
00:33:22,280 --> 00:33:24,400
You can't be in this game
if you're not an optimist.

509
00:33:24,400 --> 00:33:26,200
We've done testing in the lab,

510
00:33:26,200 --> 00:33:30,080
we see that it kills
CD19-positive targets.

511
00:33:30,080 --> 00:33:33,520
To be fair, in a dish
in an incubator.

512
00:33:33,520 --> 00:33:36,400
But, you know, this gives
us sort of faith

513
00:33:36,400 --> 00:33:38,360
in the biology, at least.

514
00:33:54,040 --> 00:33:57,080
So he's got about
50% leukaemia cells,

515
00:33:57,080 --> 00:34:00,720
but he has made his way
onto intravenous antibiotics

516
00:34:00,720 --> 00:34:02,760
because of the intermittent fevers.

517
00:34:07,840 --> 00:34:09,480
We are hydrating him, aren't we?

518
00:34:09,480 --> 00:34:10,920
He's brilliant, actually.

519
00:34:10,920 --> 00:34:15,160
He's religiously going
for the four litres of fluid a day.

520
00:34:15,160 --> 00:34:17,200
He's probably keeping it
by his bed

521
00:34:17,200 --> 00:34:21,120
because he's in there like,
you know, recording every drop.

522
00:34:21,120 --> 00:34:22,800
Of his urine output?

523
00:34:22,800 --> 00:34:25,520
Of everything.

524
00:34:25,520 --> 00:34:28,080
Claire tells me
you've been brilliant at drinking

525
00:34:28,080 --> 00:34:29,800
and keeping your fluid intake up.

526
00:34:29,800 --> 00:34:32,200
We did eight litres yesterday. OK.

527
00:34:32,200 --> 00:34:34,200
In and out. OK.

528
00:34:34,200 --> 00:34:35,880
That's extraordinary.

529
00:34:35,880 --> 00:34:38,560
So, look, day three.

530
00:34:38,560 --> 00:34:39,760
How are you feeling?

531
00:34:39,760 --> 00:34:41,160
Kicking off. OK.

532
00:34:41,160 --> 00:34:44,240
The pain's started to come through,
it's like a throbbing pain,

533
00:34:44,240 --> 00:34:46,360
so every time my heart beats,
you can feel it.

534
00:34:46,360 --> 00:34:47,640
It's like a stabbing pain.

535
00:34:47,640 --> 00:34:49,480
It's like when I relapsed.

536
00:34:53,160 --> 00:34:55,840
And again.

537
00:35:05,720 --> 00:35:06,960
All right.

538
00:35:06,960 --> 00:35:11,200
We know that the Car T cells
tend to expand in your blood

539
00:35:11,200 --> 00:35:14,640
and they expand more vigorously

540
00:35:14,640 --> 00:35:17,920
the more leukaemia cells there are
around in the body

541
00:35:17,920 --> 00:35:20,160
to act as a target for them.

542
00:35:20,160 --> 00:35:26,240
In you, what we hope is happening
is that those Car T cells

543
00:35:26,240 --> 00:35:28,720
from your brother are actually...

544
00:35:28,720 --> 00:35:33,360
They've circulated, they've
passed into the bone marrow.

545
00:35:33,360 --> 00:35:37,400
They've found the leukaemia cells
and they're starting to attack them.

546
00:35:37,400 --> 00:35:40,480
That will result
in quite a lot of pain.

547
00:35:40,480 --> 00:35:45,160
There is a small possibility
the Car T cells have been infused

548
00:35:45,160 --> 00:35:48,240
into you and they aren't managing
to expand

549
00:35:48,240 --> 00:35:50,360
or kill the leukaemia cells.

550
00:35:50,360 --> 00:35:52,400
We always have to accept
that's a risk,

551
00:35:52,400 --> 00:35:57,920
particularly when we're trying these
new medicines for the first time.

552
00:35:57,920 --> 00:36:02,000
Now, the time when we see
the maximal number of Car T cells

553
00:36:02,000 --> 00:36:04,840
in your blood is about seven
days after infusion.

554
00:36:04,840 --> 00:36:07,680
So the really hard thing
for the next few days

555
00:36:07,680 --> 00:36:10,920
is when you're feeling anxious
and scared that the leukaemia

556
00:36:10,920 --> 00:36:13,680
might be marching on.

557
00:36:13,680 --> 00:36:16,840
Actually, we just have
to hold tight.

558
00:36:16,840 --> 00:36:19,760
We probably won't know
until at least a week

559
00:36:19,760 --> 00:36:21,880
and maybe a little bit longer.

560
00:36:23,160 --> 00:36:25,560
He's got bone pain, which we can
potentially manage.

561
00:36:25,560 --> 00:36:28,320
Yes. He's not going to get
leukostasis, you know.

562
00:36:28,320 --> 00:36:30,640
Well settled. We don't know yet.

563
00:36:37,360 --> 00:36:41,600
If it's just the leukaemia on its
own then I'll be a bit pissed off.

564
00:36:41,600 --> 00:36:43,280
If it's the new treatment,

565
00:36:43,280 --> 00:36:46,160
then I'm quite happy
to take the pain

566
00:36:46,160 --> 00:36:49,480
because at least it's
getting me somewhere.

567
00:36:49,480 --> 00:36:51,400
How do you see the next few days
panning out?

568
00:36:51,400 --> 00:36:53,000
Rough.

569
00:36:55,840 --> 00:36:58,960
Now it's starting.
Now the fight's starting.

570
00:37:02,840 --> 00:37:05,880
Just repeat the sentence after me.

571
00:37:05,880 --> 00:37:10,360
The cat always hid under the couch
when dogs were in the room.

572
00:37:10,360 --> 00:37:13,200
The cat only hid under the couch

573
00:37:13,200 --> 00:37:14,960
when dogs were in the room.

574
00:37:16,640 --> 00:37:19,800
400 million Car T cells.

575
00:37:19,800 --> 00:37:22,440
Seems like quite a lot, doesn't it?

576
00:37:22,440 --> 00:37:27,800
Faith, family, friend, future,
fortune,

577
00:37:27,800 --> 00:37:30,200
forgive and forget.

578
00:37:30,200 --> 00:37:32,920
Finally, forbid.

579
00:37:32,920 --> 00:37:34,000
OK, that's enough.

580
00:37:38,720 --> 00:37:42,720
The cells are in, circulating
around somewhere.

581
00:37:42,720 --> 00:37:44,800
If there's anything you're worried
about,

582
00:37:44,800 --> 00:37:47,000
any new symptoms,
we want to know.

583
00:37:47,000 --> 00:37:49,680
Any problems with headaches,
you tell us.

584
00:37:49,680 --> 00:37:52,640
Any issues with your vision,
you tell us.

585
00:37:56,800 --> 00:37:59,120
Tell me what Mahmoud was like
as a boy.

586
00:37:59,120 --> 00:38:00,560
He was very... No. No, no, no.

587
00:38:00,560 --> 00:38:02,840
Very quiet and shy.

588
00:38:02,840 --> 00:38:06,680
And didn't have friends
until year seven.

589
00:38:06,680 --> 00:38:08,760
No. No.

590
00:38:08,760 --> 00:38:10,640
OK, I'll be quiet.

591
00:38:10,640 --> 00:38:12,600
Has it always been the two of you
growing up?

592
00:38:12,600 --> 00:38:14,880
It has always been the two of us.

593
00:38:14,880 --> 00:38:19,120
I had my daughter because I was
worried he was going to be a loner.

594
00:38:19,120 --> 00:38:21,560
What about Mahmoud's father?

595
00:38:21,560 --> 00:38:23,360
He left him when he was...

596
00:38:28,160 --> 00:38:30,080
..three months.

597
00:38:31,520 --> 00:38:33,720
She's my everything.

598
00:38:33,720 --> 00:38:35,280
I guess.

599
00:38:38,240 --> 00:38:41,840
Someone that understands
what I'm going through,

600
00:38:41,840 --> 00:38:45,720
so I cherish every time I'm with
her, even though I don't show it,

601
00:38:45,720 --> 00:38:48,560
and I can be annoying
and everything,

602
00:38:48,560 --> 00:38:52,560
but it's just my way of saying...

603
00:38:52,560 --> 00:38:53,840
..I need you.

604
00:39:15,000 --> 00:39:17,040
He's had a rough weekend.

605
00:39:19,880 --> 00:39:22,360
Over the course of the last 24
hours,

606
00:39:22,360 --> 00:39:26,360
he has developed a sort of further
increase in his fever

607
00:39:26,360 --> 00:39:27,880
to about 40 degrees,

608
00:39:27,880 --> 00:39:31,200
and he's getting increasingly
short of breath.

609
00:39:37,120 --> 00:39:39,360
He's really, really struggling.

610
00:39:42,200 --> 00:39:45,040
I think it's got to quite
a dangerous level now.

611
00:39:49,120 --> 00:39:51,840
He's always going to give it one
last extra push

612
00:39:51,840 --> 00:39:55,320
and then another one after that,
so it's never his last push.

613
00:39:55,320 --> 00:39:57,200
He's got a plan.

614
00:39:57,200 --> 00:40:00,280
You've just got to go with the plan

615
00:40:00,280 --> 00:40:02,800
and that plan is to do this.

616
00:40:07,400 --> 00:40:09,000
OK. Starting from 100,

617
00:40:09,000 --> 00:40:11,720
can you subtract seven?

618
00:40:11,720 --> 00:40:13,280
Yeah, 93.

619
00:40:16,920 --> 00:40:18,240
86.

620
00:40:23,040 --> 00:40:24,240
79.

621
00:40:29,120 --> 00:40:31,120
73.

622
00:40:31,120 --> 00:40:32,160
72.

623
00:40:36,040 --> 00:40:37,760
I've designed these treatments

624
00:40:37,760 --> 00:40:40,120
almost like you might design
a computer program

625
00:40:40,120 --> 00:40:43,360
or an electronic circuit - you kind
of pick different components.

626
00:40:43,360 --> 00:40:46,080
At some stage in the design process,
you have to say,

627
00:40:46,080 --> 00:40:47,920
"Right, this looks good enough.

628
00:40:47,920 --> 00:40:50,040
"Now we're kind of going
to go with it."

629
00:40:50,040 --> 00:40:53,560
If you can tell me words starting
with the F letter.

630
00:40:53,560 --> 00:40:55,120
Flip flop.

631
00:40:56,640 --> 00:40:57,760
Four.

632
00:41:03,840 --> 00:41:04,880
Ford.

633
00:41:09,320 --> 00:41:12,200
The issue of course to consider
here is brain function.

634
00:41:12,200 --> 00:41:14,720
I mean, you can see the beginnings
of neurotoxicity.

635
00:41:14,720 --> 00:41:16,840
We have to have a low threshold
to sort of start

636
00:41:16,840 --> 00:41:18,960
that thought process going on

637
00:41:18,960 --> 00:41:20,960
if he remains in this state.

638
00:41:24,040 --> 00:41:25,720
Often you're kind of wondering,

639
00:41:25,720 --> 00:41:29,040
when these treatments are inside
the patient and doing their thing,

640
00:41:29,040 --> 00:41:32,120
is, gosh, what if I'd used something
slightly different here?

641
00:41:32,120 --> 00:41:33,760
Or what if I'd done this the other
way round

642
00:41:33,760 --> 00:41:35,680
or used a slightly
different component?

643
00:41:35,680 --> 00:41:37,480
Would that have been better
for the patient?

644
00:41:37,480 --> 00:41:39,600
So it is quite a responsibility
to have these little

645
00:41:39,600 --> 00:41:41,880
computer programs running
inside these patients.

646
00:41:49,560 --> 00:41:51,800
How long has he been shaking for?

647
00:41:51,800 --> 00:41:53,440
Overnight.

648
00:41:53,440 --> 00:41:56,240
Overnight. They've given him
Pethidine

649
00:41:56,240 --> 00:41:58,800
and the temperatures
have been up and down.

650
00:41:58,800 --> 00:42:03,360
He hasn't slept for even 30 minutes
the whole night,

651
00:42:03,360 --> 00:42:06,080
it changes too much.

652
00:42:06,080 --> 00:42:09,280
You have to pray,
that's all I can say.

653
00:42:10,640 --> 00:42:13,920
It's through prayer and then
the medicine and the doctors

654
00:42:13,920 --> 00:42:15,600
that Mahmoud gets better.

655
00:42:15,600 --> 00:42:17,400
That's what I believe.

656
00:42:17,400 --> 00:42:21,280
Is that more your faith in God
or your faith in science?

657
00:42:21,280 --> 00:42:22,920
I think I'm combining both.

658
00:42:24,480 --> 00:42:26,720
I'm sorry you're not feeling well.

659
00:42:26,720 --> 00:42:28,880
You all right? Yes, I am.

660
00:42:28,880 --> 00:42:31,520
So what's going on at the moment,

661
00:42:31,520 --> 00:42:35,680
it's possible that this
could be down to the Car T.

662
00:42:35,680 --> 00:42:38,000
We will look today in the lab

663
00:42:38,000 --> 00:42:41,760
and see if we can see
the Car T cells in your blood.

664
00:42:52,960 --> 00:42:56,480
We gave that boy 400 million
Car T cells.

665
00:42:56,480 --> 00:42:59,240
We give him 400 million
Car T cells on Monday.

666
00:42:59,240 --> 00:43:02,400
Yeah. Right. That's not,
like, an insubstantial dose.

667
00:43:19,920 --> 00:43:21,560
I'm champing at the bit here.

668
00:43:21,560 --> 00:43:24,280
You're really making me wait here.
Come on.

669
00:43:35,000 --> 00:43:37,440
So the Car T cells are there.

670
00:43:37,440 --> 00:43:39,920
And they're there with force.

671
00:43:39,920 --> 00:43:43,320
You actually, of all of the immune
cells that are in your blood

672
00:43:43,320 --> 00:43:44,920
at the current time,

673
00:43:44,920 --> 00:43:47,360
70% of all of those are Car T cells.

674
00:43:48,520 --> 00:43:50,840
It's quite something. 70%.

675
00:43:50,840 --> 00:43:54,880
And that is probably
why you're feeling hot.

676
00:43:54,880 --> 00:43:57,400
There is something going on.

677
00:44:07,240 --> 00:44:09,760
How long will it take

678
00:44:09,760 --> 00:44:12,360
to get the results back
from the lab, do you think?

679
00:44:12,360 --> 00:44:13,760
For the trial.

680
00:44:13,760 --> 00:44:16,800
Claire will take the labs. OK.

681
00:44:18,640 --> 00:44:19,880
We need them today.

682
00:44:25,960 --> 00:44:29,240
All the markers in the blood that
we associate with Car T cells

683
00:44:29,240 --> 00:44:31,040
have gone up. Oh, right.
Is that good?

684
00:44:31,040 --> 00:44:33,320
No, no. The markers,
the inflammatory markers,

685
00:44:33,320 --> 00:44:35,720
but when we actually look
for the Car,

686
00:44:35,720 --> 00:44:37,480
we still haven't seen it today.

687
00:44:37,480 --> 00:44:39,760
But it doesn't mean
that it's not there, Graham.

688
00:44:39,760 --> 00:44:43,240
I mean that's... Because everything
about you at the moment

689
00:44:43,240 --> 00:44:45,040
is suggesting that it is.

690
00:44:49,280 --> 00:44:53,600
He's been quite fearful of falling
asleep in case he passes out.

691
00:44:55,320 --> 00:44:57,640
Because you look so poorly now,

692
00:44:57,640 --> 00:45:00,600
I don't think it's fair to make you
carry on in this way.

693
00:45:00,600 --> 00:45:03,400
I'd prefer to just try and take
the edge off this fever

694
00:45:03,400 --> 00:45:06,480
and if we take the edge off
the inflammation,

695
00:45:06,480 --> 00:45:08,760
we might see an effect
on your chest as well.

696
00:45:11,960 --> 00:45:13,880
He's suffering.

697
00:45:15,720 --> 00:45:20,600
I think we'll be duty bound
to do something to try and...

698
00:45:20,600 --> 00:45:22,840
..control that in some way.

699
00:45:24,040 --> 00:45:26,480
Which would be this drug,
Tocilizumab.

700
00:45:26,480 --> 00:45:28,920
It's administered just via a drip.

701
00:45:30,360 --> 00:45:35,200
It's impossible to be 100% sure
that Tocilizumab will not interfere

702
00:45:35,200 --> 00:45:38,560
with the potential anti-tumour
effect of this Car.

703
00:45:41,320 --> 00:45:45,280
But I also want my patient
to be alive

704
00:45:45,280 --> 00:45:48,320
and not on intensive care

705
00:45:48,320 --> 00:45:52,280
and, you know, these are
the sort of other considerations.

706
00:46:02,440 --> 00:46:03,880
He's shivering.

707
00:46:05,600 --> 00:46:06,920
How are you feeling?

708
00:46:06,920 --> 00:46:08,520
Cold.

709
00:46:12,160 --> 00:46:14,240
Yeah. Was it a lot?

710
00:46:14,240 --> 00:46:15,880
It's too much.

711
00:46:19,320 --> 00:46:20,800
LIFT: Going down.

712
00:46:27,560 --> 00:46:30,160
Sorry, don't worry.
You're just being transferred.

713
00:46:58,200 --> 00:47:02,480
Be good to get you some sleep,
wouldn't it, at some point today.

714
00:47:05,080 --> 00:47:08,360
I think at the moment we'll just
make sure that we don't need

715
00:47:08,360 --> 00:47:11,360
to intervene to try and dampen
down the Car T cells,

716
00:47:11,360 --> 00:47:13,120
but we just need to keep
reviewing

717
00:47:13,120 --> 00:47:14,960
to make sure that things
stay stable.

718
00:47:16,280 --> 00:47:19,040
There are lines in the sand.

719
00:47:19,040 --> 00:47:22,160
We wouldn't want to see him starting
to develop the requirement

720
00:47:22,160 --> 00:47:23,720
to have additional oxygen.

721
00:47:23,720 --> 00:47:27,160
That's all building a picture that
the Car T cells are really behaving

722
00:47:27,160 --> 00:47:30,320
in an aggressive way
and causing him problems

723
00:47:30,320 --> 00:47:32,440
that we need to turn back.

724
00:47:32,440 --> 00:47:36,080
I think it's good to give
it time to work.

725
00:47:36,080 --> 00:47:38,520
I've come a long way for this

726
00:47:38,520 --> 00:47:41,480
and he has come a long way for this.

727
00:47:41,480 --> 00:47:44,200
If they switch it off
and it's not done its job,

728
00:47:44,200 --> 00:47:45,640
that's a worry.

729
00:48:05,160 --> 00:48:08,600
He's had his rescue drug
to save his symptoms getting worse.

730
00:48:10,280 --> 00:48:13,320
But he still is suffering
terribly with his chest.

731
00:48:14,880 --> 00:48:16,800
Feels absolutely dreadful.

732
00:48:18,560 --> 00:48:21,200
You know, last night I was having
some quite dark thoughts.

733
00:48:21,200 --> 00:48:24,680
I'd hate to think that he was just
being used as an experiment.

734
00:48:24,680 --> 00:48:27,800
Just to scrub the whole
thing is a bit of a...

735
00:48:29,240 --> 00:48:30,720
..horror story, really.

736
00:48:33,600 --> 00:48:36,440
But I couldn't stay at the hospital
any longer.

737
00:48:36,440 --> 00:48:37,840
I needed to come home.

738
00:48:37,840 --> 00:48:39,440
He's getting very...

739
00:48:40,600 --> 00:48:44,000
..stressed, so I thought actually
he'd probably be better

740
00:48:44,000 --> 00:48:47,800
being like that on his own
for a bit, and I think, really,

741
00:48:47,800 --> 00:48:50,440
the hope is that the chest
will settle down.

742
00:48:50,440 --> 00:48:53,960
But I actually don't think that
some of the trial team have

743
00:48:53,960 --> 00:48:57,160
the answers either,
because it's a trial.

744
00:48:57,160 --> 00:49:00,080
So part of me is thinking,
why on Earth did we do this?

745
00:49:00,080 --> 00:49:03,960
And part of me is thinking
we've just got to keep going.

746
00:49:05,800 --> 00:49:08,320
None of it is in his control.

747
00:49:08,320 --> 00:49:11,360
It's entrusting your entire life
and future

748
00:49:11,360 --> 00:49:13,880
into the hands of this team,

749
00:49:13,880 --> 00:49:17,440
without knowing what the outcome
could be.

750
00:49:17,440 --> 00:49:20,520
A day, a month, a year.

751
00:49:20,520 --> 00:49:23,320
And as Graham always says, you know,
I'm doing it for the family,

752
00:49:23,320 --> 00:49:26,000
but, you know, he's got to do
something for himself as well.

753
00:49:26,000 --> 00:49:29,440
And if it were just
for the family, I would say...

754
00:49:30,880 --> 00:49:33,280
The suffering bit
is just awful.

755
00:49:33,280 --> 00:49:35,680
It's really awful watching
somebody go through that.

756
00:49:43,840 --> 00:49:46,080
Well, I have to say you look
very comfortable now.

757
00:49:46,080 --> 00:49:48,760
We haven't actually had to give you
any drugs

758
00:49:48,760 --> 00:49:51,760
to try to control this
cytokine release syndrome.

759
00:49:51,760 --> 00:49:54,320
Actually, you've done really well
on your own.

760
00:50:02,760 --> 00:50:06,400
Mahmoud's experience to date
has been very different to Graham's.

761
00:50:06,400 --> 00:50:09,080
It's easier to treat younger adults

762
00:50:09,080 --> 00:50:11,920
because, unlike
the older population,

763
00:50:11,920 --> 00:50:15,560
their bodies are more robust
and they can tolerate

764
00:50:15,560 --> 00:50:19,960
the very intensive therapies
that we have to throw at them.

765
00:50:19,960 --> 00:50:22,240
So who are these two, then?

766
00:50:22,240 --> 00:50:24,200
My sisters.

767
00:50:24,200 --> 00:50:27,160
Lena and Nian.

768
00:50:27,160 --> 00:50:29,440
Who's the older one? Lena.

769
00:50:31,800 --> 00:50:34,440
It's her birthday on Tuesday.

770
00:50:34,440 --> 00:50:37,040
8, 9, 10.

771
00:50:37,040 --> 00:50:39,320
Got her a present?

772
00:50:39,320 --> 00:50:41,840
I'll get her a present
when I'm out of here.

773
00:50:41,840 --> 00:50:44,120
I don't know what to get her.

774
00:50:44,120 --> 00:50:46,200
What do you get
a five-year-old?

775
00:50:49,040 --> 00:50:51,840
Do you miss them while you're away?

776
00:50:51,840 --> 00:50:53,920
They're annoying
but, yeah, I do.

777
00:50:55,720 --> 00:50:57,400
He's cut his hair off.

778
00:50:57,400 --> 00:51:01,880
He's cut his hair off. Yeah.

779
00:51:01,880 --> 00:51:04,080
Do you like him like that?

780
00:51:04,080 --> 00:51:05,120
Yes.

781
00:51:07,760 --> 00:51:11,000
I suppose our next hurdle
to consider is,

782
00:51:11,000 --> 00:51:15,480
what kind of disease impact has
this dose of cells had?

783
00:51:15,480 --> 00:51:17,320
We're about day 14 today,

784
00:51:17,320 --> 00:51:21,960
so we've got another 14 days
until we can actually evaluate

785
00:51:21,960 --> 00:51:25,000
his bone marrow
and see what kind of impact

786
00:51:25,000 --> 00:51:26,640
it's had on his leukaemia.

787
00:51:26,640 --> 00:51:28,480
Do you want to say bye to Mahmoud?

788
00:51:28,480 --> 00:51:30,080
Bye, Mahmoud.

789
00:51:37,000 --> 00:51:38,600
See you later.

790
00:51:42,160 --> 00:51:43,920
High five.

791
00:52:31,040 --> 00:52:32,480
Hello.

792
00:52:32,480 --> 00:52:35,520
How's your week been? I've had a
good rest, but it's nice to be back.

793
00:52:35,520 --> 00:52:37,080
I know that sounds weird!

794
00:52:37,080 --> 00:52:39,000
It's quite weird. Yeah, yeah.

795
00:52:42,680 --> 00:52:46,280
You don't look - compared to
yesterday afternoon -

796
00:52:46,280 --> 00:52:48,720
like your breathing is more easy.

797
00:52:50,520 --> 00:52:53,160
I had a better night last night.

798
00:52:53,160 --> 00:52:54,520
Did you? Yeah.

799
00:52:57,120 --> 00:52:58,280
OK.

800
00:52:58,280 --> 00:53:01,520
So I think clinically at the moment,

801
00:53:01,520 --> 00:53:05,160
the leukaemia cells never
went away totally.

802
00:53:07,600 --> 00:53:09,720
I think we can't say for certain

803
00:53:09,720 --> 00:53:13,720
that another dose
of the Car T cells

804
00:53:13,720 --> 00:53:19,560
will work in a significantly better
way than the first dose.

805
00:53:22,200 --> 00:53:23,840
And the other thing,

806
00:53:23,840 --> 00:53:25,800
the big elephant in the room,

807
00:53:25,800 --> 00:53:27,840
is that...

808
00:53:27,840 --> 00:53:31,560
..your chest at the moment
is slowly getting worse.

809
00:53:33,200 --> 00:53:36,320
That would have to go away
completely, wouldn't it,

810
00:53:36,320 --> 00:53:39,640
to be able to... Well, I think
infusing a load of T cells into you

811
00:53:39,640 --> 00:53:41,320
with very severe respiratory
problems,

812
00:53:41,320 --> 00:53:42,880
I think you wouldn't survive them.

813
00:53:42,880 --> 00:53:45,280
Kill me. Yeah.

814
00:53:46,360 --> 00:53:48,840
I think we're up against it.

815
00:53:48,840 --> 00:53:50,760
And if it worsens still?

816
00:53:50,760 --> 00:53:52,440
I think if your chest worsens,

817
00:53:52,440 --> 00:53:55,080
I think it's grim.

818
00:53:55,080 --> 00:53:56,760
OK.

819
00:53:58,560 --> 00:54:00,960
I'm trying to be honest.

820
00:54:00,960 --> 00:54:05,680
For example, I think if you ended up
ventilated on a breathing machine,

821
00:54:05,680 --> 00:54:07,720
I don't think you'd survive.

822
00:54:09,640 --> 00:54:11,160
I don't want that.

823
00:54:11,160 --> 00:54:14,080
And typically...

824
00:54:14,080 --> 00:54:16,880
..how long between...

825
00:54:16,880 --> 00:54:18,680
..chest failure and heart failure?

826
00:54:18,680 --> 00:54:21,120
I don't think it would be very long.

827
00:54:21,120 --> 00:54:22,960
Hours, days?

828
00:54:22,960 --> 00:54:27,240
I think probably hours or days
rather than days or weeks.

829
00:54:30,440 --> 00:54:32,480
I mean, you've been watching
everything

830
00:54:32,480 --> 00:54:34,240
that's been happening and...

831
00:54:59,040 --> 00:55:01,440
Have you got any questions?

832
00:55:01,440 --> 00:55:02,760
Are you sure?

833
00:55:02,760 --> 00:55:06,640
Do everything we can to try
and sort my lungs out.

834
00:55:11,480 --> 00:55:15,000
Overnight last night,
his chest got worse,

835
00:55:15,000 --> 00:55:18,680
so he went from two litres
of oxygen to needing 35.

836
00:55:18,680 --> 00:55:21,440
So he's on a mask with 35%.

837
00:55:21,440 --> 00:55:23,880
His chest sounds worse.

838
00:55:23,880 --> 00:55:26,880
It's just very noisy
and crackly.

839
00:55:30,800 --> 00:55:32,120
From a trial perspective,

840
00:55:32,120 --> 00:55:34,040
he's received the therapy

841
00:55:34,040 --> 00:55:36,400
and he had a transient response.

842
00:55:37,920 --> 00:55:40,840
You know, that's the best
that we can kind of say

843
00:55:40,840 --> 00:55:43,280
at the current time on day 17.

844
00:55:51,360 --> 00:55:55,880
We didn't ever guarantee
that we would see responses.

845
00:55:55,880 --> 00:55:58,040
We were sort of hopeful
that we would see a response,

846
00:55:58,040 --> 00:56:00,080
but it's such early work

847
00:56:00,080 --> 00:56:05,120
and this study is designed to see
whether there is toxicity associated

848
00:56:05,120 --> 00:56:07,040
with giving these cells.

849
00:56:08,880 --> 00:56:11,320
Do you feel any sense of
responsibility?

850
00:56:11,320 --> 00:56:14,680
Yeah. I mean, I guess the reality is

851
00:56:14,680 --> 00:56:17,760
that, you know, I can't
help my personality

852
00:56:17,760 --> 00:56:21,640
and I particularly, you know,
I'm very sort of, like, passionate

853
00:56:21,640 --> 00:56:24,640
about this. I do feel that this
therapy, you know,

854
00:56:24,640 --> 00:56:29,080
is really important to the future
of haematology and...

855
00:56:30,680 --> 00:56:33,680
And I probably, to some extent,
whether it be, you know,

856
00:56:33,680 --> 00:56:35,920
verbally or perhaps even
unconsciously

857
00:56:35,920 --> 00:56:38,440
convey that to patients and their
families.

858
00:56:38,440 --> 00:56:41,320
I'm sure, you know, the process
of talking to me,

859
00:56:41,320 --> 00:56:45,000
perhaps they get the impression
that this really is going to be...

860
00:56:45,000 --> 00:56:47,880
..a viable...

861
00:56:47,880 --> 00:56:50,840
..potential life-saving
option for them.

862
00:56:53,360 --> 00:56:57,400
With Graham, I convey all
the potential risks to him

863
00:56:57,400 --> 00:56:59,160
and the fact that it may not work,

864
00:56:59,160 --> 00:57:02,520
and it's just about how far you
lead people down that road.

865
00:57:05,040 --> 00:57:07,920
Do I think he came into
this with his eyes open?

866
00:57:07,920 --> 00:57:10,760
Maybe you can never have
your eyes fully open.

867
00:57:10,760 --> 00:57:15,200
It's easy to distance yourself
from these concepts of toxicity.

868
00:57:15,200 --> 00:57:19,840
Sounds like somebody else in some
other board in some other hospital.

869
00:57:19,840 --> 00:57:21,920
But I don't dispute the fact

870
00:57:21,920 --> 00:57:24,560
that it's very scary
when it's ongoing.

871
00:57:46,320 --> 00:57:47,800
KNOCKING

872
00:57:54,240 --> 00:57:57,040
There is no wire and no mask.
No oxygen.

873
00:57:57,040 --> 00:57:58,840
What's happened?

874
00:57:58,840 --> 00:58:00,440
You've performed miracles.

875
00:58:00,440 --> 00:58:01,520
How are you feeling?

876
00:58:01,520 --> 00:58:02,680
I'm coughing up a lot now

877
00:58:02,680 --> 00:58:05,400
which is good, because it means
the crap's coming out,

878
00:58:05,400 --> 00:58:06,840
but we're getting there.

879
00:58:06,840 --> 00:58:10,040
The good news is, as you can see,
I've got my physio. Oh, yeah.

880
00:58:10,040 --> 00:58:12,880
Game plan for me now is get
this chest fixed,

881
00:58:12,880 --> 00:58:16,120
build my strength back up
and then get back in the ring

882
00:58:16,120 --> 00:58:18,240
and have another go. Super, super.

883
00:58:18,240 --> 00:58:20,520
That's the plan, so I'm following
the instructions.

884
00:58:20,520 --> 00:58:24,080
I've doubled up on what he's asked
me to do, then last night,

885
00:58:24,080 --> 00:58:27,320
I actually had the best night's
sleep I've ever had. Wow!

886
00:58:31,920 --> 00:58:34,760
I need to get my strength back now

887
00:58:34,760 --> 00:58:36,960
and I'm a bit better.

888
00:58:36,960 --> 00:58:39,480
And I'm eating everything.
How's it taste?

889
00:58:39,480 --> 00:58:41,760
It's actually not too bad.

890
00:58:41,760 --> 00:58:45,600
So this is beef lasagne and it
actually does taste like lasagne.

891
00:58:50,840 --> 00:58:52,920
Last Friday, I was dying.

892
00:58:54,760 --> 00:58:56,600
Everybody was convinced -

893
00:58:56,600 --> 00:58:59,000
and we're talking
about experts here.

894
00:58:59,000 --> 00:59:02,120
Everybody thought, that's it,
he's not making it.

895
00:59:02,120 --> 00:59:04,880
I'm still here
and I'm still fighting.

896
00:59:04,880 --> 00:59:07,360
And I will not give up.

897
00:59:07,360 --> 00:59:08,960
I just won't.

898
00:59:23,480 --> 00:59:27,440
Graham is very special
because he's hugely optimistic.

899
00:59:27,440 --> 00:59:30,880
He's prepared to, like,
invest in the, you know,

900
00:59:30,880 --> 00:59:33,800
what the dream outcome is,
and he will take

901
00:59:33,800 --> 00:59:35,960
whatever sort of, you know...

902
00:59:35,960 --> 00:59:37,600
I mean, and it's been suffering.

903
00:59:37,600 --> 00:59:39,680
Let's not sort of mince
the words around that.

904
00:59:39,680 --> 00:59:41,560
It has been struggling, you know,

905
00:59:41,560 --> 00:59:43,920
the complete existential crisis.

906
00:59:43,920 --> 00:59:45,120
But he's still here.

907
00:59:45,120 --> 00:59:48,360
We just... I feel as if to some
extent the boot has been removed

908
00:59:48,360 --> 00:59:51,240
from my neck, you know, in terms
of I've been given a little bit

909
00:59:51,240 --> 00:59:53,240
of extra breathing room
to try and figure out

910
00:59:53,240 --> 00:59:56,680
what our next moves
on the board are.

911
01:00:08,400 --> 01:00:11,120
Primarily, I'm really
motivated by data.

912
01:00:14,480 --> 01:00:20,240
I'm not particularly motivated
by seeing patients as individuals.

913
01:00:20,240 --> 01:00:22,680
I'm very happy that they do
get better,

914
01:00:22,680 --> 01:00:24,760
but what we're really trying
to do here

915
01:00:24,760 --> 01:00:28,080
is something that is much bigger
than an individual patient.

916
01:01:01,480 --> 01:01:03,200
Directly looking after patients

917
01:01:03,200 --> 01:01:07,160
is always a completely different
experience to doing laboratory work.

918
01:01:16,560 --> 01:01:20,160
If you're a scientist,
you have to remain objective.

919
01:01:21,920 --> 01:01:25,640
What you don't want to do
is make wrong decisions

920
01:01:25,640 --> 01:01:27,480
because you're clouded by emotion.

921
01:01:31,960 --> 01:01:34,800
Think with your head,
not with your heart.

922
01:01:39,320 --> 01:01:41,120
You can feel with your heart,

923
01:01:41,120 --> 01:01:43,840
but, you know, you have
to think with your head.

924
01:01:54,760 --> 01:01:58,560
There's no point having a
super-emotional scientist.

925
01:01:58,560 --> 01:02:01,280
Those individual patients
need me to have made

926
01:02:01,280 --> 01:02:03,240
the right design decisions.

927
01:02:04,880 --> 01:02:06,480
And I suppose, to be honest,

928
01:02:06,480 --> 01:02:09,440
there is a certain amount of luck
as well.

929
01:02:19,320 --> 01:02:21,960
So you know what's on the cards
for this afternoon.

930
01:02:21,960 --> 01:02:23,960
We're going to do
that bone marrow test

931
01:02:23,960 --> 01:02:26,400
because you've reached
the magic number now.

932
01:02:26,400 --> 01:02:29,040
One whole month since
your dose of the Car T cells.

933
01:02:29,040 --> 01:02:31,320
It's quite amazing, isn't it?
It's just gone....

934
01:02:31,320 --> 01:02:33,120
It seems it's gone fast for me,

935
01:02:33,120 --> 01:02:35,320
I don't know if
it's gone fast for you

936
01:02:35,320 --> 01:02:37,800
lying in the hospital bed
this whole time.

937
01:02:37,800 --> 01:02:39,640
I've just been in this room.

938
01:02:39,640 --> 01:02:42,600
I do sympathise,
but fingers crossed, right?

939
01:02:42,600 --> 01:02:45,320
Get this bone marrow and then...

940
01:02:47,720 --> 01:02:49,320
..what's next afterwards?

941
01:02:49,320 --> 01:02:51,400
Well, it depends what it shows.

942
01:02:51,400 --> 01:02:52,800
OK.

943
01:02:55,080 --> 01:02:56,040
Mahmoud, wait.

944
01:02:58,160 --> 01:03:01,360
This is clearly a pivotal
point for Mahmoud.

945
01:03:02,560 --> 01:03:05,400
He wants to help you
hold all of that.

946
01:03:05,400 --> 01:03:09,160
We've seen evidence of
Car T cells in his blood.

947
01:03:10,480 --> 01:03:12,120
That's hugely reassuring to me,

948
01:03:12,120 --> 01:03:15,400
and it tells me that the product
that we've made, it's got legs,

949
01:03:15,400 --> 01:03:18,680
it's been able to ingraft
in Mahmoud.

950
01:03:18,680 --> 01:03:22,040
Whether it's delivered any kind of
biological effect, though,

951
01:03:22,040 --> 01:03:24,280
is the big question.

952
01:03:24,280 --> 01:03:26,520
You need to uncover your head.

953
01:03:30,880 --> 01:03:32,640
What are you watching?

954
01:03:37,400 --> 01:03:39,320
Mahmoud.

955
01:03:39,320 --> 01:03:41,760
Yeah? What are you watching.

956
01:03:43,480 --> 01:03:44,600
YouTube.

957
01:03:59,920 --> 01:04:02,880
My name's Clive, I'll be helping
to look after you.

958
01:04:56,320 --> 01:05:00,200
My family, we've had our fair share
of experience with cancer.

959
01:05:02,600 --> 01:05:05,520
Very close grandfather
who developed lung cancer

960
01:05:05,520 --> 01:05:07,880
that was detected very late.

961
01:05:07,880 --> 01:05:12,760
And also my dad, he developed quite
an aggressive prostate cancer.

962
01:05:12,760 --> 01:05:17,360
It sort of profoundly changes
how you think about illness.

963
01:05:36,880 --> 01:05:40,600
I'm aware of what it's like to be
the person on the other side.

964
01:05:44,640 --> 01:05:46,680
Maybe not as nervous as the patient,

965
01:05:46,680 --> 01:05:50,360
but I'm certainly very apprehensive
around about these time points.

966
01:05:52,760 --> 01:05:55,400
You don't want to take away
anyone's hope.

967
01:06:04,480 --> 01:06:06,160
Hello.

968
01:06:06,160 --> 01:06:08,640
Hello! How are you?

969
01:06:08,640 --> 01:06:11,880
Very quiet and peaceful in here.

970
01:06:11,880 --> 01:06:15,680
Just to say, we have a bit
of the marrow results back.

971
01:06:15,680 --> 01:06:19,800
So far, all we have is the fluid bit
of the marrow.

972
01:06:19,800 --> 01:06:22,440
But I can say, when we look at it,

973
01:06:22,440 --> 01:06:25,680
we can't see any evidence of
disease.

974
01:06:25,680 --> 01:06:29,160
There are no bad cells at all.

975
01:06:29,160 --> 01:06:32,120
Now the reason that we're not sort
of jumping up and down

976
01:06:32,120 --> 01:06:34,640
and, well, you know, we have to wait
for the solid lump

977
01:06:34,640 --> 01:06:37,240
of the bone marrow, and that gets
sent off to the lab

978
01:06:37,240 --> 01:06:39,760
and will take about a week. OK?

979
01:06:39,760 --> 01:06:42,000
Oh, bless her. Oh.

980
01:06:43,760 --> 01:06:45,560
That's so good.

981
01:06:45,560 --> 01:06:48,640
It's really good.
I think hopefully, you know,

982
01:06:48,640 --> 01:06:51,680
as Claire was saying,
we'll get the rest of it back, yeah?

983
01:06:51,680 --> 01:06:53,000
You all right?

984
01:06:53,000 --> 01:06:54,400
We're really, really...

985
01:06:54,400 --> 01:06:55,960
I mean, we're really hopeful,

986
01:06:55,960 --> 01:07:00,200
but we have to see all the evidence
before we can absolutely be sure,

987
01:07:00,200 --> 01:07:03,400
but we are, you know, really happy
with that result so far.

988
01:07:03,400 --> 01:07:04,920
Thank you, Claire. Thank you, Ben.

989
01:07:07,760 --> 01:07:09,160
See you later.

990
01:07:13,840 --> 01:07:16,000
What's this...? What?

991
01:07:16,000 --> 01:07:17,920
What's this? Well done.

992
01:07:17,920 --> 01:07:20,480
What's this?

993
01:07:22,880 --> 01:07:25,720
You've done very well.
You've been very brave.

994
01:07:27,600 --> 01:07:28,840
OK. OK.

995
01:07:30,960 --> 01:07:32,200
OK. My God.

996
01:07:34,360 --> 01:07:37,120
They have just changed
our lives today.

997
01:07:38,880 --> 01:07:42,480
They've lifted the weight on us.

998
01:07:44,920 --> 01:07:47,200
They don't know
what they've just done to us.

999
01:07:49,640 --> 01:07:50,720
You OK?

1000
01:07:52,520 --> 01:07:54,880
I'm just waiting for next week.

1001
01:07:54,880 --> 01:07:56,480
Don't get too hasty.

1002
01:07:58,120 --> 01:08:00,560
I think Mum's celebrating too early.

1003
01:08:00,560 --> 01:08:02,360
OK.

1004
01:08:02,360 --> 01:08:06,120
I'm sorry, I'm not going
to celebrate it.

1005
01:08:06,120 --> 01:08:07,840
But I'm happy.

1006
01:08:07,840 --> 01:08:09,080
That's good.

1007
01:08:25,560 --> 01:08:29,400
Graham didn't respond to the first
dose of Car T cells.

1008
01:08:31,240 --> 01:08:33,720
But we've actually manufactured
three doses for him

1009
01:08:33,720 --> 01:08:35,480
at the very beginning.

1010
01:08:37,920 --> 01:08:41,720
Each dose is higher in terms
of cell numbers than the last dose.

1011
01:08:46,920 --> 01:08:50,520
He's always had
a very positive manner.

1012
01:08:50,520 --> 01:08:55,800
And he probably feels under some
pressure to stay positive for Mellie

1013
01:08:55,800 --> 01:08:58,240
and he's probably trying
to stay positive for us,

1014
01:08:58,240 --> 01:09:00,400
you know, so that we don't
doubt him -

1015
01:09:00,400 --> 01:09:03,040
I don't know. Anyways,
he's obviously...

1016
01:09:03,040 --> 01:09:06,360
..like we all are, you know,
complicated characters.

1017
01:09:09,240 --> 01:09:13,280
I was hopelessly weak at school
with my chest.

1018
01:09:13,280 --> 01:09:15,000
If we went on a cross-country run,

1019
01:09:15,000 --> 01:09:16,920
I was always the wheezy kid
in the back.

1020
01:09:18,760 --> 01:09:21,000
The turning point for me
was when I was very young

1021
01:09:21,000 --> 01:09:24,240
and I went to the doctors and he sat
down very kindly

1022
01:09:24,240 --> 01:09:27,680
and listed all the things I'd never
be able to do in life.

1023
01:09:27,680 --> 01:09:29,720
That really messed me up in a way.

1024
01:09:29,720 --> 01:09:31,720
In a good way, actually, ironically.

1025
01:09:31,720 --> 01:09:33,760
Not in the way he intended.

1026
01:09:33,760 --> 01:09:37,960
28, 29...

1027
01:09:37,960 --> 01:09:39,920
My father was very supportive,

1028
01:09:39,920 --> 01:09:43,760
so what I used to do is I used to go
out and try and run on my own

1029
01:09:43,760 --> 01:09:46,440
and I went from being the weedy kid
at the back

1030
01:09:46,440 --> 01:09:49,120
to going to Sandhurst.

1031
01:09:49,120 --> 01:09:51,840
Getting commissioned.

1032
01:09:51,840 --> 01:09:54,080
I was the first officer we had.

1033
01:09:54,080 --> 01:09:56,320
We never failed on anything.

1034
01:09:56,320 --> 01:09:59,760
You were saying your dad was good
when you were a kid. Yes.

1035
01:09:59,760 --> 01:10:01,840
He was a strange man in many ways.

1036
01:10:01,840 --> 01:10:05,280
He'd pull up and it would
say, "Private wood - keep out."

1037
01:10:05,280 --> 01:10:06,840
"Come on. In we go."

1038
01:10:06,840 --> 01:10:09,320
"Dad, it says private, keep out."

1039
01:10:09,320 --> 01:10:12,560
"Yeah. Not us.
That's for other people."

1040
01:10:12,560 --> 01:10:15,720
He just used to hate authority.

1041
01:10:15,720 --> 01:10:18,040
We'd go and mess around
in the woods and stuff

1042
01:10:18,040 --> 01:10:20,320
and if - the
Duke of Bedford's estate -

1043
01:10:20,320 --> 01:10:22,920
if the gamekeeper come over
and whatever and said,

1044
01:10:22,920 --> 01:10:25,200
"You're not supposed to be in here."

1045
01:10:25,200 --> 01:10:28,640
He just used to say,
"Fuck off. We're here."

1046
01:10:31,080 --> 01:10:33,720
Was he quite heroic
to you because of that?

1047
01:10:33,720 --> 01:10:36,880
I'm not sure heroic
is the right word.

1048
01:10:36,880 --> 01:10:40,200
There's a lot of things I'm very
grateful for from my father

1049
01:10:40,200 --> 01:10:43,640
and there's a lot I'm not
grateful for at all.

1050
01:10:43,640 --> 01:10:47,680
He was extremely ill - Parkinson's
and various other things.

1051
01:10:47,680 --> 01:10:49,160
They basically said,

1052
01:10:49,160 --> 01:10:52,800
"You're going to be bedridden
on morphine all the time."

1053
01:10:52,800 --> 01:10:54,600
And...

1054
01:10:54,600 --> 01:10:56,040
..he didn't want to do that.

1055
01:10:56,040 --> 01:10:59,640
So he used to manage to drag
himself out of bed,

1056
01:10:59,640 --> 01:11:01,840
drove to the train station,

1057
01:11:01,840 --> 01:11:04,560
left my mum a pathetic scrawling

1058
01:11:04,560 --> 01:11:07,440
and jumped in front of a train.

1059
01:11:07,440 --> 01:11:10,280
And thought he was doing
everyone a favour.

1060
01:11:17,480 --> 01:11:18,920
Done.

1061
01:11:43,640 --> 01:11:47,040
Seems to be the right size so we can
get the hand grenade in there.

1062
01:11:47,040 --> 01:11:49,280
Hopefully not a hand grenade.
Well, it is, mate.

1063
01:11:49,280 --> 01:11:51,920
Let's be honest, it's three
times the cells this time

1064
01:11:51,920 --> 01:11:54,160
so it's going to go with a bang.

1065
01:12:14,240 --> 01:12:17,920
OK? So we've got it,
it's thawed.

1066
01:12:17,920 --> 01:12:19,440
Away we go.

1067
01:12:25,200 --> 01:12:26,760
No going back now.

1068
01:12:31,680 --> 01:12:35,360
Do you think Graham will be alive
in a few months?

1069
01:12:35,360 --> 01:12:38,000
Well, you know, I am not God.

1070
01:12:39,640 --> 01:12:42,360
If the cells can deliver
a kind of response,

1071
01:12:42,360 --> 01:12:45,520
he's robust enough, I think,
that he'll see it through.

1072
01:12:47,600 --> 01:12:50,600
So I look at Graham
with the optimism

1073
01:12:50,600 --> 01:12:53,880
with which I, you know, have
sort of thrown myself 100%

1074
01:12:53,880 --> 01:12:56,640
into all the studies.
That is that we have to believe

1075
01:12:56,640 --> 01:12:59,760
that there is a chance
that these will work for him.

1076
01:13:06,320 --> 01:13:08,560
Trying to find all your results.

1077
01:13:08,560 --> 01:13:10,120
Last week, we had most of them back

1078
01:13:10,120 --> 01:13:12,560
but we were just waiting for
the most important one for us -

1079
01:13:12,560 --> 01:13:14,800
the molecular result.

1080
01:13:14,800 --> 01:13:17,840
I am very pleased to
be able to say to you

1081
01:13:17,840 --> 01:13:20,680
that there is no molecular evidence

1082
01:13:20,680 --> 01:13:25,000
of any nasty leukaemia at all
anywhere to be seen in that sample.

1083
01:13:25,000 --> 01:13:29,160
So does that mean I'm cancer-free?

1084
01:13:29,160 --> 01:13:32,200
Absolutely. You are cancer free.

1085
01:13:32,200 --> 01:13:34,120
OK. OK. Yeah.

1086
01:13:34,120 --> 01:13:36,960
So we're all, like, you know
I don't usually get very excited

1087
01:13:36,960 --> 01:13:40,520
but I was very excited when I got
that piece of information. OK.

1088
01:13:40,520 --> 01:13:43,200
We still have some problems.

1089
01:13:43,200 --> 01:13:45,920
Your bone marrow is
a fairly empty-looking

1090
01:13:45,920 --> 01:13:47,800
lonely place at the moment.

1091
01:13:47,800 --> 01:13:50,160
You need some red cells,
you need some platelets

1092
01:13:50,160 --> 01:13:52,360
and you need some neutrophils,
all right?

1093
01:13:52,360 --> 01:13:54,560
So we have to watch this space.

1094
01:13:54,560 --> 01:13:56,200
OK.

1095
01:13:57,440 --> 01:13:59,280
Hello. Hello.

1096
01:13:59,280 --> 01:14:01,920
Hello, hi. Hi, so I got the news.

1097
01:14:01,920 --> 01:14:03,720
OK, what is it?

1098
01:14:03,720 --> 01:14:05,160
Are you ready?

1099
01:14:05,160 --> 01:14:06,360
Yeah, I'm ready, what is it?

1100
01:14:06,360 --> 01:14:08,400
I'm cancer-free.

1101
01:14:08,400 --> 01:14:11,520
That is the best news ever.

1102
01:14:13,680 --> 01:14:15,440
How do you feel?

1103
01:14:15,440 --> 01:14:16,720
I'm OK.

1104
01:14:16,720 --> 01:14:18,760
Congratulations!

1105
01:14:18,760 --> 01:14:20,040
Thank you.

1106
01:14:20,040 --> 01:14:22,000
I can see him.

1107
01:14:22,000 --> 01:14:23,880
Hello, Mahmoud. Hello.

1108
01:14:29,920 --> 01:14:33,000
You've got your Mahmoud
poker face on.

1109
01:14:33,000 --> 01:14:34,880
Maybe...

1110
01:14:34,880 --> 01:14:38,680
..I'm just a chilled-out person.

1111
01:14:38,680 --> 01:14:40,320
Just chilled out.

1112
01:14:40,320 --> 01:14:45,280
I think that's true, or under the
surface are you less chilled out?

1113
01:14:45,280 --> 01:14:48,840
Just on the outside
I am chilled out.

1114
01:14:48,840 --> 01:14:50,480
What about on the inside?

1115
01:14:50,480 --> 01:14:52,400
Very scared.

1116
01:14:54,600 --> 01:14:58,040
You've been trying to seem calm
for yourself or for others?

1117
01:14:59,200 --> 01:15:03,480
One time, when I was starting my
treatment for the bone marrow

1118
01:15:03,480 --> 01:15:07,520
transplant, after one hour I
said to my mum, "I've had enough."

1119
01:15:09,720 --> 01:15:13,240
"I don't want to do it any more."
Because I was scared.

1120
01:15:17,840 --> 01:15:22,480
I told her that and she left work
and said she couldn't do it

1121
01:15:22,480 --> 01:15:25,200
any more cos she was stressed.

1122
01:15:25,200 --> 01:15:29,000
I didn't want to have to
make her do that again.

1123
01:15:29,000 --> 01:15:31,520
So I kept calm.

1124
01:15:31,520 --> 01:15:36,840
I ate food, drink water, just
so that never happened again.

1125
01:15:39,840 --> 01:15:41,960
She's my best friend.

1126
01:15:58,920 --> 01:16:02,560
If you really work your way
down to the very core of it,

1127
01:16:02,560 --> 01:16:05,200
Martin is the innovator.

1128
01:16:08,200 --> 01:16:13,320
His understanding of the biology,
and his imagination....

1129
01:16:14,440 --> 01:16:17,680
Few other people could
have taken us this far.

1130
01:16:18,760 --> 01:16:21,080
So I'm told all sorts of
good things.

1131
01:16:21,080 --> 01:16:23,680
You're looking a lot better
than you were this time last week,

1132
01:16:23,680 --> 01:16:26,280
and for that I'm really pleased.

1133
01:16:26,280 --> 01:16:28,760
Yeah? Yes! At last!

1134
01:16:38,720 --> 01:16:42,160
Scientific progress is not
an overnight thing.

1135
01:16:44,560 --> 01:16:47,880
The Car T-Cell field is built on
a huge amount of knowledge that's

1136
01:16:47,880 --> 01:16:50,720
been accumulated
over the last century.

1137
01:16:50,720 --> 01:16:54,520
He should feel more energetic now,
doesn't he?

1138
01:16:54,520 --> 01:16:57,360
From the understanding of the immune
system all the way through to

1139
01:16:57,360 --> 01:16:59,560
understanding of the human genome.

1140
01:17:01,280 --> 01:17:03,720
It's a lot of hard work.

1141
01:17:03,720 --> 01:17:07,560
And also sometimes having some
inspirational moments, which often

1142
01:17:07,560 --> 01:17:10,800
are disappointing because what you
think is an inspirational idea

1143
01:17:10,800 --> 01:17:13,000
actually doesn't work.

1144
01:17:13,000 --> 01:17:17,760
But occasionally you have a really
good idea and it does work.

1145
01:17:17,760 --> 01:17:20,400
One of the most important things...
KNOCKING

1146
01:17:20,400 --> 01:17:22,400
..is not giving up,
and being persistent.

1147
01:17:22,400 --> 01:17:24,320
Hi. Hi.

1148
01:17:26,160 --> 01:17:27,680
Haven't seen you for ages.

1149
01:17:27,680 --> 01:17:30,120
You're looking nice,
with your little scarf on.

1150
01:17:30,120 --> 01:17:31,960
HE CHUCKLES

1151
01:17:33,680 --> 01:17:35,680
WATER RUNNING

1152
01:17:35,680 --> 01:17:38,440
You're still sitting there looking
like the healthiest

1153
01:17:38,440 --> 01:17:40,920
sickie on the planet.
Well, my red count's gone up.

1154
01:17:40,920 --> 01:17:42,560
Platelets have gone up.

1155
01:17:43,720 --> 01:17:45,880
Something's happening.

1156
01:17:52,880 --> 01:17:55,040
HEART BEATS

1157
01:17:57,120 --> 01:17:59,880
Again. And out.

1158
01:18:01,080 --> 01:18:03,640
Very, very much improved.

1159
01:18:03,640 --> 01:18:06,360
I mean, clearly your charts
are just pristine.

1160
01:18:06,360 --> 01:18:09,520
And in terms of the
Car T cells... Yeah.

1161
01:18:09,520 --> 01:18:13,400
..I mean, obviously I haven't
had any temperature symptoms yet.

1162
01:18:13,400 --> 01:18:16,640
Yeah, yeah. Should I be worried
about the fact that it doesn't seem

1163
01:18:16,640 --> 01:18:18,200
to have kicked in yet? I don't...

1164
01:18:18,200 --> 01:18:20,920
Look, I don't think that there's
anything that any of us can do

1165
01:18:20,920 --> 01:18:22,560
about whatever's going on. Yeah.

1166
01:18:22,560 --> 01:18:26,200
I know it's very hard, but we just
need to basically try... Try and put

1167
01:18:26,200 --> 01:18:28,200
it out of your head for now. Yeah.

1168
01:18:29,360 --> 01:18:32,680
So, on the strength of that, I think
there was some sort of tentative

1169
01:18:32,680 --> 01:18:36,920
discussion about, go home maybe
tonight if everything's OK.

1170
01:18:36,920 --> 01:18:39,640
I don't know how you'd feel about
that... I'd be delighted to go back.

1171
01:18:39,640 --> 01:18:41,000
..maybe weekend leave. Yeah?

1172
01:18:44,680 --> 01:18:46,880
I feel a bit lost, really.

1173
01:18:48,640 --> 01:18:50,800
We've got no visual symptoms.

1174
01:18:52,400 --> 01:18:57,280
But at the same time, the scores
are good, so we don't...

1175
01:18:57,280 --> 01:18:59,320
We don't really know
what's going on.

1176
01:18:59,320 --> 01:19:00,840
I don't think THEY do.
HE LAUGHS

1177
01:19:00,840 --> 01:19:03,400
I don't think they do
know what's going on.

1178
01:19:03,400 --> 01:19:05,800
Yeah, I mean, how long have
you been here now? 73 days.

1179
01:19:07,240 --> 01:19:10,640
Be good to get out. I'd quite like
to have a glass of wine, actually.

1180
01:19:15,960 --> 01:19:17,760
LIFT: Going down.

1181
01:19:25,680 --> 01:19:28,320
We've taken Mahmoud
through this journey.

1182
01:19:29,560 --> 01:19:32,200
It's not been an
easy ride for anyone.

1183
01:19:34,040 --> 01:19:36,280
To be able to actually send him
home to his family,

1184
01:19:36,280 --> 01:19:39,920
it's a really special day,
for him and also for us.

1185
01:19:58,200 --> 01:20:01,120
He realises he's going to be
under active surveillance

1186
01:20:01,120 --> 01:20:02,680
for months and months.

1187
01:20:04,520 --> 01:20:08,160
The US have most data where
they've looked at children

1188
01:20:08,160 --> 01:20:10,040
up to the age of 18.

1189
01:20:12,880 --> 01:20:16,280
They report really high rates
of complete response at one month

1190
01:20:16,280 --> 01:20:19,680
after treatment -
93% achieving a complete response.

1191
01:20:20,760 --> 01:20:25,400
Six months, those numbers have
dropped down to about sort of 70%.

1192
01:20:26,520 --> 01:20:31,080
If you get to 12 months,
50%, then the chances are

1193
01:20:31,080 --> 01:20:35,160
that you will carry on in that way.

1194
01:20:35,160 --> 01:20:37,480
There seems to be something
about getting to 12 months

1195
01:20:37,480 --> 01:20:40,680
where all those survival curves
just basically seem to plateau

1196
01:20:40,680 --> 01:20:44,720
and you don't tend to see people
continuing to fall off.

1197
01:20:54,880 --> 01:20:57,320
CHILD SHOUTS EXCITEDLY

1198
01:21:01,760 --> 01:21:03,400
You're back!

1199
01:21:06,840 --> 01:21:10,920
For him it will be a huge relief
to get home, to be in his own bed,

1200
01:21:10,920 --> 01:21:14,040
be away from the beeping machines,

1201
01:21:14,040 --> 01:21:15,800
and just to be free
of us in hospital.

1202
01:21:17,640 --> 01:21:20,040
What is it you're wanting to
do now that you're home?

1203
01:21:22,200 --> 01:21:24,680
I actually don't know
what to do now.

1204
01:21:35,480 --> 01:21:38,760
Old wind's a bit nippy,
actually, isn't it?

1205
01:21:38,760 --> 01:21:41,600
Here he is. How we doing?

1206
01:21:41,600 --> 01:21:43,320
Have you been down here
before, then?

1207
01:21:43,320 --> 01:21:46,080
Yeah, we've stayed a few times
across at the place

1208
01:21:46,080 --> 01:21:48,600
just straight opposite.

1209
01:21:48,600 --> 01:21:51,160
There's no TV over there,
which is great.

1210
01:21:51,160 --> 01:21:54,600
What do you do? I buy wine,
actually. Do you? Yeah.

1211
01:21:54,600 --> 01:21:57,440
Oh, did you tell me that before?
Yes, yeah...

1212
01:21:57,440 --> 01:21:59,320
Yeah, last time we were here, but
I've been...

1213
01:21:59,320 --> 01:22:01,920
I haven't been too well,
so we've not been out for a bit.

1214
01:22:01,920 --> 01:22:03,360
Oh, right.

1215
01:22:03,360 --> 01:22:06,720
You laid up at the moment? Well,
I'm just kind of getting over it.

1216
01:22:06,720 --> 01:22:09,120
I've had quite a long stay
in hospital recently... Yeah?

1217
01:22:09,120 --> 01:22:11,040
..so I'm just taking it steady.
Yeah.

1218
01:22:11,040 --> 01:22:14,240
And what's great about this
place is it's, you know,

1219
01:22:14,240 --> 01:22:17,360
you've got a lot space, you're not
near a load of other people.

1220
01:22:17,360 --> 01:22:20,680
Cos I've... My immune system's
a bit smashed up. Yeah.

1221
01:22:20,680 --> 01:22:23,120
The joys of leukaemia.
HE CHUCKLES

1222
01:22:23,120 --> 01:22:24,880
We're here and we're
having a nice time.

1223
01:22:24,880 --> 01:22:26,400
Yeah, we're having
a nice time, so...

1224
01:22:26,400 --> 01:22:28,720
Right, cheers, then. Cheers,
then. Nice to see you. And you.

1225
01:22:43,800 --> 01:22:45,560
I love it here.

1226
01:22:49,640 --> 01:22:51,880
Ben's back from uni,

1227
01:22:51,880 --> 01:22:55,840
and we're trying to do... Steal
a couple of days where we can.

1228
01:22:58,400 --> 01:23:05,600
I'm really badly smashed up still.
My limbs don't work properly yet.

1229
01:23:05,600 --> 01:23:08,720
The nerve damage has been
quite extensive.

1230
01:23:10,520 --> 01:23:14,040
Got a long way to go before
I'm back to where it was.

1231
01:23:14,040 --> 01:23:16,840
What's down the road, then,
in terms of treatment?

1232
01:23:16,840 --> 01:23:19,920
They're going to do a bone marrow
and see where the treatment's got.

1233
01:23:21,720 --> 01:23:24,960
Do you still have faith in the
treatment? Yeah, I do, yeah.

1234
01:23:24,960 --> 01:23:27,360
I mean, something
weird's been going on.

1235
01:23:28,600 --> 01:23:32,280
Everybody's very noncommittal,
medically, at the minute.

1236
01:23:33,320 --> 01:23:35,560
I don't know whether that's
a good thing or a bad thing,

1237
01:23:35,560 --> 01:23:37,600
but it doesn't matter, really.

1238
01:23:37,600 --> 01:23:40,360
At the end of the day it will
be what the bone marrow says.

1239
01:23:50,960 --> 01:23:53,000
DEEP BREATHING

1240
01:23:56,480 --> 01:23:58,680
DRILL BUZZES

1241
01:23:58,680 --> 01:24:00,640
HE GROANS

1242
01:24:30,200 --> 01:24:33,520
If you wouldn't mind, if you go
through the bone marrow results,

1243
01:24:33,520 --> 01:24:35,640
just get that done. No, absolutely.

1244
01:24:35,640 --> 01:24:38,320
If you're OK with that.
I am absolutely fine with that.

1245
01:24:38,320 --> 01:24:40,880
All right, so, compared to before

1246
01:24:40,880 --> 01:24:44,360
you started this second cycle,
you know, there's

1247
01:24:44,360 --> 01:24:48,280
much less disease present,
but it's not gone.

1248
01:24:58,400 --> 01:25:00,040
I'm so sorry.

1249
01:25:00,040 --> 01:25:02,480
And any sign of the Car T cells?

1250
01:25:02,480 --> 01:25:05,640
Minimal. Is that unexpected
or is that... I'm surprised.

1251
01:25:05,640 --> 01:25:08,280
I mean, you know, you have to
understand that, like, I don't

1252
01:25:08,280 --> 01:25:11,000
certainly have all the answers
either, but I am surprised

1253
01:25:11,000 --> 01:25:14,280
by that. I don't...
I can't quite understand it.

1254
01:25:14,280 --> 01:25:15,680
And so we have options.

1255
01:25:15,680 --> 01:25:18,320
So, either we say the final dose
of Car T, the biggest dose

1256
01:25:18,320 --> 01:25:23,120
of all might help to kind
of like mop up this final

1257
01:25:23,120 --> 01:25:26,240
kind of population of cells.

1258
01:25:26,240 --> 01:25:27,960
We would do that next week.

1259
01:25:27,960 --> 01:25:30,400
Another option is to say
if you just don't want to hear

1260
01:25:30,400 --> 01:25:33,200
about Car T cells any more, you say,
"Right, well, you know, I know

1261
01:25:33,200 --> 01:25:36,840
"that I could potentially think
about going back on ponatinib."

1262
01:25:36,840 --> 01:25:40,960
Recognise that's probably
not a long-term solution.

1263
01:25:40,960 --> 01:25:43,880
For me, I would want to go with the
third dose... Yeah. ..because the

1264
01:25:43,880 --> 01:25:48,160
other options that you're describing
are really... That's when nothing

1265
01:25:48,160 --> 01:25:49,600
else is working.

1266
01:26:02,200 --> 01:26:03,880
How's this week been?

1267
01:26:05,040 --> 01:26:07,480
Awful.

1268
01:26:07,480 --> 01:26:09,200
Really awful.

1269
01:26:12,120 --> 01:26:16,040
We had clinic and then we could
tell that each other were thinking

1270
01:26:16,040 --> 01:26:18,800
things that we didn't really talk
about, and then when we got home,

1271
01:26:18,800 --> 01:26:21,480
Graham actually got quite angry.

1272
01:26:21,480 --> 01:26:25,880
When I was saying, you know, what's
best for him and for us as a family,

1273
01:26:25,880 --> 01:26:29,000
I was just throwing it out there
that maybe the third infusion

1274
01:26:29,000 --> 01:26:31,040
isn't the right thing to do.

1275
01:26:32,280 --> 01:26:36,560
He just said, "Well, I might as well
give up, then - sell my motorbike."

1276
01:26:36,560 --> 01:26:39,680
It went from here to just
complete nosedive.

1277
01:26:44,920 --> 01:26:46,480
Thank you, darling. Tunnock's.

1278
01:26:48,760 --> 01:26:50,640
Well, it was good that
we had the discussions.

1279
01:26:50,640 --> 01:26:53,400
They weren't very nice,
between the two us, but...

1280
01:26:53,400 --> 01:26:56,080
It's been a difficult week.

1281
01:26:56,080 --> 01:26:58,400
But we got there. Yeah.

1282
01:27:01,720 --> 01:27:04,640
If I go with the cells next week,
it could kill me,

1283
01:27:04,640 --> 01:27:07,200
or it could make me
seriously ill and, like...

1284
01:27:07,200 --> 01:27:10,640
Whatever how long I've got left,
I just don't want to waste it

1285
01:27:10,640 --> 01:27:15,120
by being in hospital,
so I'm not giving up at all.

1286
01:27:15,120 --> 01:27:17,360
I'm just being realistic.

1287
01:27:17,360 --> 01:27:19,000
And so that's it, done.

1288
01:27:20,400 --> 01:27:24,480
We know where we are. And it's not
a complete disaster.

1289
01:27:24,480 --> 01:27:27,040
It's not as if the trial itself has
been wasted.

1290
01:27:27,040 --> 01:27:29,360
I mean, they've got some
good stuff out from it,

1291
01:27:29,360 --> 01:27:31,640
from what's happened with me,
that they'll be

1292
01:27:31,640 --> 01:27:34,640
able to pass on to the next people.

1293
01:27:34,640 --> 01:27:39,080
So in that sense I don't feel that
I'm kind of just abandoning

1294
01:27:39,080 --> 01:27:42,120
everything. I've...
I've done my bit.

1295
01:27:42,120 --> 01:27:43,960
Life, for me, is about this.

1296
01:27:43,960 --> 01:27:47,080
It's about sitting, the two of us,
out here, having a cup of tea.

1297
01:27:47,080 --> 01:27:50,480
Eating Tunnock's Teacakes.
Eating Tunnock's Teacakes and,

1298
01:27:50,480 --> 01:27:52,800
you know, cooking for Amy and Ben,

1299
01:27:52,800 --> 01:27:55,440
and just getting on
with family life.

1300
01:27:55,440 --> 01:27:59,600
It's not about sitting
in hospital in green pyjamas.

1301
01:27:59,600 --> 01:28:02,160
Yeah, so normal service
has been resumed.

1302
01:28:03,680 --> 01:28:05,600
Shall we go
and have a look at the patch

1303
01:28:05,600 --> 01:28:07,560
and see what's growing
in there? Yeah.

1304
01:28:07,560 --> 01:28:11,480
I don't know whether any of
the new stuff has come out.

1305
01:28:19,400 --> 01:28:23,520
But there's stuff like that little
one there, little ones there.

1306
01:28:23,520 --> 01:28:25,720
That's from last year, I think.

1307
01:28:31,480 --> 01:28:34,680
There's nothing at this end.
Butterfly. Flutterby.

1308
01:29:09,160 --> 01:29:12,920
Over the last week or so for
Mahmoud, his counts came back and,

1309
01:29:12,920 --> 01:29:14,800
at a very low level, we can see

1310
01:29:14,800 --> 01:29:18,520
leukaemic cells, which
obviously is a massive blow

1311
01:29:18,520 --> 01:29:23,760
to even be thinking that's what
we can see. The very low level

1312
01:29:23,760 --> 01:29:27,800
we are seeing - sort of around two
in every 10,000 cells, of healthy

1313
01:29:27,800 --> 01:29:31,080
cells - they do look like there's
leukaemic cells there.

1314
01:29:42,800 --> 01:29:46,640
Please can you not tell him
until later?

1315
01:29:46,640 --> 01:29:49,480
So he can have a good quality...

1316
01:29:50,920 --> 01:29:53,600
..whatever. Yeah.

1317
01:29:53,600 --> 01:29:56,600
I know he's 18.
I know he's 18, but...

1318
01:29:57,800 --> 01:30:00,680
..I would...

1319
01:30:00,680 --> 01:30:05,560
As a mother, I know I'll be
the one picking up the pieces.

1320
01:30:05,560 --> 01:30:09,600
He shouldn't be told, because
that will shatter his life.

1321
01:30:13,080 --> 01:30:15,560
I don't wish it on a mother.

1322
01:30:16,720 --> 01:30:18,760
Watching her son

1323
01:30:18,760 --> 01:30:20,960
having treatment, drugs,

1324
01:30:20,960 --> 01:30:22,760
medication,

1325
01:30:22,760 --> 01:30:24,240
one after the other.

1326
01:30:25,400 --> 01:30:29,320
And you're hoping every time
he goes through it

1327
01:30:29,320 --> 01:30:31,560
and then recovers a bit,

1328
01:30:31,560 --> 01:30:33,360
and you're hoping
he's going to get better,

1329
01:30:33,360 --> 01:30:36,640
and it's not going away.

1330
01:30:43,480 --> 01:30:46,640
When a patient relapses, what the
tumour sometimes can do is it can

1331
01:30:46,640 --> 01:30:51,080
figure out - in an evolutionary
sense - what a T-cell is

1332
01:30:51,080 --> 01:30:54,320
looking for, and it can
decide to switch it off.

1333
01:30:54,320 --> 01:30:57,560
So then the T-cell comes along,
it's targeting something called

1334
01:30:57,560 --> 01:31:00,360
CD19 on the tumour surface,
and it kills

1335
01:31:00,360 --> 01:31:02,400
99.999% of the tumours.

1336
01:31:04,080 --> 01:31:07,840
And one tumour somewhere
has a random mutation.

1337
01:31:07,840 --> 01:31:11,560
That random mutation
switches off CD19,

1338
01:31:11,560 --> 01:31:15,840
and now you've got one tumour cell
that the Car T-Cell can't see

1339
01:31:15,840 --> 01:31:18,880
any more, so the Car T-Cell comes
along, finds it and ignores it -

1340
01:31:18,880 --> 01:31:21,640
doesn't have CD19 - and then that
tumour cell then just starts

1341
01:31:21,640 --> 01:31:24,760
dividing and dividing and dividing
and takes over the patient.

1342
01:31:29,040 --> 01:31:32,760
There's a certain pain that I get
when my leukaemia is back,

1343
01:31:32,760 --> 01:31:35,520
and I feel it back already.

1344
01:31:35,520 --> 01:31:37,480
What is it? It's back pain.

1345
01:31:39,400 --> 01:31:42,840
I think this is the last time,
cos I can't do any more treatment.

1346
01:31:42,840 --> 01:31:46,760
Cos physically and emotionally,
I'm extremely limited.

1347
01:31:46,760 --> 01:31:50,160
You don't think you could
cope with more treatment? No.

1348
01:31:50,160 --> 01:31:53,200
So, what, you'd
refuse more treatment?

1349
01:31:53,200 --> 01:31:54,920
I think I would.

1350
01:31:59,320 --> 01:32:04,000
I wouldn't want to do that, because
then my sisters, my mum, our family

1351
01:32:04,000 --> 01:32:07,520
members won't be able to see me,
cos I'll be dead.

1352
01:32:09,920 --> 01:32:13,120
Do you worry about
the impact on them? I do.

1353
01:32:15,560 --> 01:32:18,080
They see their brother every day.

1354
01:32:18,080 --> 01:32:19,840
And then he's gone.

1355
01:32:21,200 --> 01:32:23,600
Just someone they used to know.

1356
01:32:40,800 --> 01:32:43,120
I don't get to control my dreams.

1357
01:32:45,480 --> 01:32:47,640
I dream about falling.

1358
01:32:51,320 --> 01:32:55,560
When I was younger, I'd just wake up
and just run to my mum's bedroom

1359
01:32:55,560 --> 01:32:57,080
if I had a scary dream.

1360
01:32:58,520 --> 01:33:00,040
It was a reflex.

1361
01:33:02,600 --> 01:33:04,160
I'm her first-born.

1362
01:33:05,680 --> 01:33:09,720
It'll be very tough to lose someone
you've spent so much time with.

1363
01:33:16,480 --> 01:33:19,120
How fast is my leukaemia growing?

1364
01:33:19,120 --> 01:33:22,000
So, it is coming up quite quickly.

1365
01:33:22,000 --> 01:33:24,840
You can see leukaemic cells
just down the microscope now.

1366
01:33:24,840 --> 01:33:28,080
They are there in very clear
numbers, unfortunately, and so

1367
01:33:28,080 --> 01:33:30,320
that's what does make it clear-cut.

1368
01:33:31,960 --> 01:33:35,560
So it looks like the Car T cells
are not able to see

1369
01:33:35,560 --> 01:33:38,640
the leukaemic cells, and so they
aren't able to attack them, and that

1370
01:33:38,640 --> 01:33:40,920
seems to be what has happened.

1371
01:33:40,920 --> 01:33:45,720
We are so disappointed about our
Car Ts, you know, because we really

1372
01:33:45,720 --> 01:33:48,800
were so hopeful that they
could get you out of a really

1373
01:33:48,800 --> 01:33:50,400
sticky situation,

1374
01:33:50,400 --> 01:33:53,920
and it just is the case
that the tumour was too smart.

1375
01:33:56,560 --> 01:33:59,760
I don't think we're going to be
able to get rid of this leukaemia.

1376
01:34:05,680 --> 01:34:08,120
You want talk to any friends
or anything tonight

1377
01:34:08,120 --> 01:34:11,960
about all this? No, it's too hard.
No-one understands, do they?

1378
01:34:11,960 --> 01:34:14,960
It's not that they don't understand,
it's just... It's just too hard to

1379
01:34:14,960 --> 01:34:17,840
tell your friend that
you're...dying.

1380
01:34:21,440 --> 01:34:23,520
To put them in that situation.

1381
01:34:26,600 --> 01:34:30,440
I think it's all too much right now,
but I think you need to think,

1382
01:34:30,440 --> 01:34:33,480
if it was your friend, you'd want
to support them, wouldn't you?

1383
01:34:33,480 --> 01:34:35,920
I know, but I don't know...
How to do that. No.

1384
01:34:58,360 --> 01:35:01,360
Oh, it's so nice and sunny.
Anyone got Stella?

1385
01:35:01,360 --> 01:35:05,760
LAUGHTER
Go ahead. I'm going to take
my anti-sickness right now.

1386
01:35:05,760 --> 01:35:07,560
SCREAMING

1387
01:35:07,560 --> 01:35:09,840
Oh, my God! Just look at that!

1388
01:35:11,880 --> 01:35:14,920
SCREAMING
Holy shit!

1389
01:35:18,160 --> 01:35:21,200
How scared were you?
It was all right.

1390
01:35:21,200 --> 01:35:24,040
Just all right? You didn't cry?
No, I didn't cry. HE cried.

1391
01:35:24,040 --> 01:35:25,920
HE SCREAMS

1392
01:35:45,240 --> 01:35:47,280
I'm not even in there.
You can't even... Get in.

1393
01:35:47,280 --> 01:35:48,840
Hold on. Look.

1394
01:35:50,680 --> 01:35:52,680
CAMERA APP CLICKS

1395
01:35:55,520 --> 01:35:59,600
We've known Mahmoud since year
three. We've been, like, close

1396
01:35:59,600 --> 01:36:02,400
friends, because we played...
Remember playing basketball?

1397
01:36:02,400 --> 01:36:05,720
He used to be... Yeah, he used to...
He used to be good at it.
LAUGHTER

1398
01:36:05,720 --> 01:36:08,760
End of year eight I met him, yeah.
And I was like,

1399
01:36:08,760 --> 01:36:12,560
"I want to sit next to this guy."
He just had a friendly face.

1400
01:36:12,560 --> 01:36:15,440
"I want to sit next to this guy.
He looks funny."
THEY LAUGH

1401
01:36:44,320 --> 01:36:47,440
Cancers are constantly changing,

1402
01:36:47,440 --> 01:36:49,840
but they do have an Achilles heel,
which is they can't create.

1403
01:36:52,000 --> 01:36:56,280
While as conscious engineers
we can be much more creative,

1404
01:36:56,280 --> 01:37:00,960
and it's through this creativity
that we can corner cancers.

1405
01:37:00,960 --> 01:37:05,040
I have no doubts that Car T-Cell
therapy will work.

1406
01:37:05,040 --> 01:37:07,280
We know what problems
we need to solve, and we know

1407
01:37:07,280 --> 01:37:08,880
how to solve them.

1408
01:37:10,920 --> 01:37:14,520
In some ways, the patients
in whom the treatment doesn't work

1409
01:37:14,520 --> 01:37:17,800
are more important than a patient
where the treatment works.

1410
01:37:17,800 --> 01:37:21,480
That's really where you
can learn the most.

1411
01:37:21,480 --> 01:37:24,360
The knowledge that we've gained
will then help us to refine our

1412
01:37:24,360 --> 01:37:27,320
treatments and hopefully help many
hundreds or thousands or millions

1413
01:37:27,320 --> 01:37:29,240
of people, ultimately.

1414
01:37:36,040 --> 01:37:39,760
I don't know how much families think
about that, but that

1415
01:37:39,760 --> 01:37:43,800
is something that really should
bring them some comfort at least.

1416
01:37:59,240 --> 01:38:01,600
ENGINE REVS

1417
01:38:14,480 --> 01:38:17,520
I don't think we would ever say
we wish we'd never done it, never.

1418
01:38:19,800 --> 01:38:23,640
He wanted to be part of
making other people better.

1419
01:38:26,680 --> 01:38:28,760
Everything starts somewhere.