Ka Hoʻokele ʻana i nā Pilikia Lōʻihi o ka CAR-T Therapy: Nā ʻIke mai ke Kanesa Kūlohelohe

Ua hoʻololi ka lāʻau lapaʻau cell Chimeric Antigen Receptor (CAR)-T i ka mālama ʻana i nā maʻi hematologic, e hāʻawi ana i ka manaʻolana i nā poʻe maʻi me nā maʻi paʻakikī ʻē aʻe. Eia nō naʻe, ʻo nā pilikia lōʻihi e like me nā maʻi a me nā maʻi ʻino lua e mau ana i kahi hopohopo palekana koʻikoʻi, e like me kahi ʻatikala hou ma Ka maʻi ʻaʻai kūlohelohe.

Ua hoʻohana nui ʻia ka lāʻau lapaʻau CAR-T ma muli o kona hopena kupaianaha i nā hoʻokolohua lapaʻau a me nā noi maoli. ʻOiai ua lilo nā ʻawaʻawa koʻikoʻi e like me ka cytokine release syndrome (CRS) a me ka immune effector cell-associated neurotoxicity syndrome (ICANS) i mea hiki ke hoʻokele ʻia me nā holomua i ka mālama kākoʻo, ke hōʻike nei nā loiloi hou i ka nui o ka make ʻole o ka relapse (NRM) ma muli o nā maʻi a me nā maʻi ʻino lua i waena o nā mea pane CAR-T.

He meta-analysis e pili ana i ka 7,604 lymphoma a me ʻO ka Myeloma lehulehu Ua hōʻike nā mea maʻi i loaʻa i ka lāʻau lapaʻau CAR-T i kahi helu NRM holoʻokoʻa o 6.8%, e loli ana ma waena o nā maʻi like ʻole a me nā mea i kūkulu ʻia e CAR-T.ʻO nā maʻi i helu ʻia no ka hapa nui o nā hihia NRM, pili ʻole i ka Huahana CAR-T ʻo ia iho a i ʻole ka maʻi kumu. ʻOiai ka hopena koʻikoʻi o COVID-19 i ka wā o ke aʻo ʻana, ua hāʻawi nā maʻi bacteria a me nā fungal i 20% o nā make e pili ana i ka maʻi. Ua like kēia mau helu me nā mea i ʻike ʻia ma hope o ka hoʻoili ʻana o nā cell stem hematopoietic autologous (auto-HSCT).

No ka hōʻemi ʻana i kēia mau pilikia, hoʻoikaika nā mea noiʻi i ka pono o nā mea hana wānana e like me ka helu CAR-HEMATOTOX, kahi e loiloi ai i nā mea e like me ka mālama hematopoietic a me ka mumū baseline. Kōkua kēia ʻōnaehana helu i ka ʻike ʻana i nā maʻi kiʻekiʻe e pōmaikaʻi paha mai nā antibiotics prophylactic i hana kūikawā ʻia a me ka nānā ʻana i ka pale ʻana. ʻO ka mea nui, ua pili ka hematotoxicity cell effector cell-associated hematotoxicity (ICAHT) me kahi helu NRM kiʻekiʻe (14% versus 4.5% i nā hihia ʻaʻole koʻikoʻi).

ʻO nā maʻi malignancies lua, e like me nā myelodysplastic syndromes (MDS), acute myeloid leukemia (AML), a me nā carcinomas, he mau pilikia koʻikoʻi ʻē aʻe. Ua pili nui kēia mau maʻi ʻino i nā lāʻau lapaʻau koʻikoʻi mua e like me ka chemotherapy a me ka auto-HSCT ma mua o ka huahana CAR-T ponoʻī. Ua ʻike ʻia ka hematopoiesis clonal, kahi mea mua i ka MDS/AML e pili ana i ka lāʻau lapaʻau, a hiki i ka 56% o nā maʻi ma mua o ka hoʻokomo ʻana o CAR-T.

Ke noiʻi ʻia nei ke kuleana o ka lāʻau lapaʻau CAR-T i loko o kēia mau maʻi ʻino. ʻOiai nā hihia o CAR-T-induced Lymphoma T-Cell ua hōʻike ʻia, ʻaʻole maopopo ka pilina kumu. I hoʻokahi hihia koʻikoʻi, ua ʻike ʻia nā pae CAR-RNA kiʻekiʻe i loko o kahi lymphoma T-cell gastrointestinal post-CAR-T therapy, akā naʻe ua kāpae nā loiloi genetic i ka hoʻokomo ʻana o CAR ma ke ʻano he kumu nui o ka malignancy.

Nā Hoʻolālā no ka Hoʻokele ʻana i nā Pōpilikia
No ka hoʻonui ʻana i ka ʻikepili pōmaikaʻi-pilikia o ka lāʻau lapaʻau CAR-T, paipai nā kānaka noiʻi i ke komo mua ʻana i nā poʻe maʻi me nā laina liʻiliʻi o ka lāʻau lapaʻau mua e hōʻemi i ka ʻona cumulative. Hiki i nā ʻōnaehana helu wānana a me ka hahai lōʻihi ʻana o nā mea loaʻa CAR-T ke hoʻonui hou i ka palekana ma o ka hiki ʻana ke ʻike mua a me ka hoʻokele ʻana i nā pilikia.

Hōʻike ka ʻatikala i ke koʻikoʻi o ka hōʻike ʻana i nā hanana ʻino piha i nā hoʻokolohua lapaʻau a me nā papa inoa, ʻoi aku hoʻi no nā maʻi, nā maʻi ʻino lua, a me NRM. E kōkua kēlā ʻikepili i nā kauka lapaʻau e hoʻomaʻamaʻa i nā protocol lapaʻau a me nā pae koho koho maʻi.

Hopena
ʻOiai ke hōʻike nei ka lāʻau lapaʻau CAR-T i ka hiki ke hoʻōla ʻia no nā maʻi hematologic, he mea nui ka hoʻokele ʻana i kona mau pilikia lōʻihi. Pono ka noiʻi e hiki mai ana e kālele i ka hoʻomaʻemaʻe ʻana i nā mea hana wānana a me ka ʻimi ʻana i nā lāʻau lapaʻau ʻē aʻe no nā poʻe maʻi ʻelemakule a nāwaliwali paha i ʻole e ʻae maikaʻi i nā mea ʻawaʻawa e pili ana iā CAR-T.

He mea hoʻomanaʻo kēia hana hou i ka pono e hoʻokaulike i ka pono a me ka palekana i nā lāʻau lapaʻau hou, e hōʻoia ana i nā hopena maikaʻi loa no nā maʻi ma ka honua holoʻokoʻa.