{"id":94408,"date":"2026-10-28T15:20:00","date_gmt":"2026-10-28T21:20:00","guid":{"rendered":"https:\/\/www.uchealth.org\/today\/?p=94408"},"modified":"2026-10-28T15:20:00","modified_gmt":"2026-10-28T21:20:00","slug":"a-unicycle-riders-guide-to-car-t-cell-therapy","status":"publish","type":"post","link":"https:\/\/www.uchealth.org\/today\/a-unicycle-riders-guide-to-car-t-cell-therapy\/","title":{"rendered":"A unicycle rider\u2019s guide to CAR T cell therapy"},"content":{"rendered":"
<\/div>
\"Mike
Mike Kalush keeps his balance on the Mule Deer Trail in Golden Gate Canyon State Park. Photo by Todd Neff, for UCHealth.<\/figcaption><\/figure>\n

Not everybody looking down the barrel of having their immune system savaged and then replenished with genetically engineered killer T cells prepares by riding down a mountain on a unicycle. But this was what Mike Kalush, 65, wanted to do.<\/p>\n

On a sunny Friday morning in late September, the Littleton resident donned gear that, except for the shin pads, would look at home on a road bike\u2019s occupant. This would not be a road ride, but rather a five-mile downhill section of Golden Gate State Park\u2019s Mule Deer Trail that the popular mountain biking site, MTB Project, rates as blue-black in difficulty<\/a>. That\u2019s assuming two wheels.<\/p>\n

\"Mike
Mike Kalush rides his unicycle down Mule Deer Trail in Golden Gate Canyon State Park. Photo courtesy of Mike Kalush.<\/figcaption><\/figure>\n

Anne Trujillo, the retired Denver 7 news anchor, observed as her husband reacquainted himself atop his lime-green one-wheeler on a trail just above the Gap Lot.<\/p>\n

\u201cThe idea is not to get hurt,\u201d she said.<\/p>\n

While striking a physical balance, Kalush would strike a conceptual one: between the trail\u2019s immediate physical risks and his mental and physical readiness for the CAR T-cell therapy scheduled for the following week.<\/p>\n

\u201cI\u2019m going to get this ride in if it kills me,\u201d Kalush said. \u201cIt\u2019s important for me to get on with my life and do these things. And I want to go into this CAR T as healthy and strong as possible.\u201d<\/p>\n

A blood cancer diagnosis and failed R-CHOP lead to CAR T-cell therapy<\/strong><\/h2>\n

Kalush was diagnosed with diffuse large B-cell lymphoma, or DLBCL, in October 2025. It\u2019s a blood cancer of the immune system\u2019s B cells. Four increasingly brutal rounds of R-CHOP<\/a> chemoimmunotherapy at a local cancer center didn\u2019t quite wipe it out. He was referred to UCHealth University of Colorado Hospital<\/a> for CAR T-cell therapy, a now-standard second-line treatment that takes an academic medical center to manage. Dr. Steven Bair<\/a>, a UCHealth blood cancer specialist and assistant professor<\/a> of hematology at University of Colorado Anschutz School of Medicine<\/a>, took the lead.<\/p>\n

Bair walked Kalush through the CAR T-cell therapy process. Preparatory scans and blood tests would make sure it\u2019s as safe for Kalush as it is for the vast majority of lymphoma patients. An apheresis session would collect T cells from his blood. They would be sent off to a lab and genetically engineered to produce a surface protein, a chimeric antigen receptor \u2014 the \u201cCAR\u201d in CAR T. The receptors let the reengineered T cell lock onto the CD19 proteins found on the surfaces of B cells. That initiates a T-cell attack program and, ultimately, the destruction of target B cells.<\/p>\n

After T-cell collection, the lab would then let the CAR T cells multiply for the better part of three weeks. Many lymphoma patients undergo what\u2019s called bridging therapy in the meantime. The chemotherapy, immunotherapy, or radiation therapy keeps serious cases of lymphoma in check in the roughly six-week gap between initial consultation and infusion of engineered CAR T cells.<\/p>\n

\"Mike
Mike Kalush focused on staying strong and having fun before he received CAR-T cell therapy. Photo courtesy of Mike Kalush.<\/figcaption><\/figure>\n

As CAR-T cells multiply, the patient prepares for therapy<\/strong><\/h2>\n

Kalush wouldn\u2019t need bridging therapy: His recurrent lymphoma had shown up in a single armpit lymph node that had been surgically removed, and his PET scans were clean after that. So, once the CAR T cells arrived from Bristol Myers Squibb (the company behind Breyanzi<\/a>, the CAR T-cell therapy at hand), Kalush would go straight into three days of lymphodepleting chemotherapy. That knocks back a patient\u2019s B cells as well as T cells. Doing that brings less competition from native T cells and fewer B cells for the CAR T cells to tackle.<\/p>\n

\"Dr.
Dr. Steven Bair, a UCHealth blood cancer specialist and assistant professor of hematology at University of Colorado Anschutz School of Medicine.<\/figcaption><\/figure>\n

After the lymphodepleting chemotherapy, Kalush would be hospitalized for the CAR T cell infusion, and for about a week after that. That extended stay is necessary because meddling with the immune system \u2014 the convoluted product of a billion years of trial-and-error jousting with pathogens \u2014 can bring surprises. Two in particular: a spike of dangerous inflammation called cytokine release syndrome, or CRS<\/a>, and immune effector cell-associated neurotoxicity syndrome, or ICANS<\/a>.<\/p>\n

The risk of either drops significantly after about two weeks, Bair told Kalush, so, as long as he could get back to the hospital quickly if symptoms presented, he could go home well before the 14-day point. Then it would be a matter of watching closely for about a month.<\/p>\n

One important aspect of recovery is that of the immune system. Bair figures CAR T cell therapy beats the immune system back to about one-third of its typical potency until it strengthens to about two-thirds of baseline within a month or two. Over the course of the first year, it rebuilds to 80% to 90% of normal, and it may never quite fully recover, Bair said. In those early months, patients must keep immunodeficiency in mind when considering social events and traveling, he said.<\/p>\n

Then, three months out, there would be a PET scan.<\/p>\n

\u201cIf it\u2019s a complete remission, that make us feel optimistic that the patient\u2019s in a pretty good spot,\u201d Bair said.<\/p>\n

And if Kalush is cancer-free a year out, he stands a good chance of being among the 40% to 50% of UCHealth patients for whom CAR T-cell therapy is a durable cure.<\/p>\n

\"Days
Days before Mike Kalush was scheduled for a CAR T-cell therapy infusion to treat his diffuse large B cell lymphoma, he hit the trail to enjoy a beautiful fall day on his mountain unicycle. Photo by Todd Neff, for UCHealth.<\/figcaption><\/figure>\n

A unicycle is not quite a hiking-trail unicorn, but almost<\/strong><\/h2>\n

In the meantime, there was Mule Deer Trail. Anne and niece Stefanie Sarconi had driven back down to park and wait at the Old Barn Knoll lot some 1,200 vertical feet below. There she would meet Kalush when he finished the roughly five-mile trail section.<\/p>\n

Kalush set off, alternatively dodging, rolling over, or bailing before various rocks, roots, and drops. Bailing often involved abruptly letting the unicycle crash to the ground as his body thrust forward in a way that evoked a child jumping off a moving swing at its lowest point.<\/p>\n

While mountain unicycling is not unheard of, and newer versions of Kalush\u2019s Nimbus Oregon 26, with its 4.3-inch knobby tires and disc brake, can be had for around $800, mountain unicycling is rarely heard of. The occasional hiker\u2019s reaction ranged from \u201cUnicycle \u2014 wow\u201d to \u201cYou don\u2019t see many of those out here.\u201d Kalush has a couple of go-to responses, the most notable being, \u201cThis is all I got left.\u201d<\/p>\n

You can learn a lot about somebody when they\u2019re navigating down a mountain on a unicycle:<\/strong><\/h4>\n
    \n
  • That Kalush had been unicycling since he was 12 and now owned a half dozen one-wheelers.<\/li>\n
  • That he was a longtime TV news cameraman and producer.<\/li>\n
  • That he and Anne met when she, then a new reporter, was assigned to him because he was generally nice to the greenhorns (this worked out well).<\/li>\n
  • That lugging heavy cameras had cost him two rotator-cuff surgeries.<\/li>\n
  • That he does not use the unicycle\u2019s brake, and that, as a result, the downhill stresses the legs.<\/li>\n
  • That his progressively worsening limp after bailing and walking had to do with torn meniscus in his left knee.<\/li>\n
  • That he had, for four years, operated a food truck called Mike\u2019s Coneys.<\/li>\n
  • That he was from Flint, Mich., a state known for its Coney Island hot dogs despite Coney Island technically being in New York.<\/li>\n
  • That he had a grown son and daughter and eight sisters, six of whom had been, at some point, single parents.<\/li>\n
  • That he had, in 2012, unicycled 509 miles across Colorado in 15 days to raise awareness of and honor single parents.<\/li>\n
  • And that this ride was a psychological escape.<\/li>\n<\/ul>\n

    \u201cWhen you have cancer, even if you\u2019re not feeling bad, you know, every three days, you’re at the doctor, you\u2019re getting emails, you\u2019re getting bills,\u201d he said. \u201cI mean, your life just becomes cancer. Whether you like it or not, no matter how sick you are, you never have a single day without thinking about it.\u201d<\/p>\n

    No room for cancer on Mule Deer Trail<\/strong><\/h2>\n

    But here, as the trail ducked in and out of pine forests and meadows where the aspen had begun to turn, there was no thinking about cancer.<\/p>\n

    \"While
    This ride on Mule Deer Trail was shorter than the 509 miles Mike Kalush once rode across Colorado, but bumpier. Photo by Todd Neff, for UCHealth.<\/figcaption><\/figure>\n

    \u201cWhen I’m on the unicycle, you see how detailed everything has to be, right? You hit one little tiny rock and you’re off, so you’re just in full focus mode,\u201d Kalush said.<\/p>\n

    One little tiny rock sent him into a sizable tree he hugged not for environmental reasons. Another one sent him dive rolling, ninjalike, onto the trail ahead. He ended up on his feet. Twice-a-week yoga and a month or so of preparatory rides on the High Line Canal did little to explain such prowess.<\/p>\n

    \u201cHe\u2019s not one to act his age. Never has been,\u201d Trujillo had remarked before Kalush set off down the trail. His body seems to have followed suit.<\/p>\n

    An hour and 45 minutes later, that exhausted body pedaled into the Ole Barn Knoll lot, where Trujillo and Stephanie waited. He hugged them.<\/p>\n

    One conquest down, one to go.<\/p>\n

    It will be months before Kalush knows if the CAR T-cells now coursing through his body end his lymphoma. Bair likes his patient\u2019s odds. He suspects that Kalush\u2019s optimism and energy will boost them.<\/p>\n

    \u201cI really feel like there\u2019s something to it when patients approach their situations with grit and determination. Oftentimes I think they get through it better. They\u2019re more motivated. They\u2019re moving around during treatment instead of lying in bed all day,\u201d he said. \u201cI think that serves people well.\u201d<\/p>\n

     <\/p>\n","protected":false},"excerpt":{"rendered":"

    Not everybody looking down the barrel of having their immune system savaged and then replenished with genetically engineered killer T cells prepares by riding down a mountain on a unicycle. But this was what Mike Kalush, 65, wanted to do. 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