Kev Tswj Xyuas Cov Teeb Meem Ntev ntawm Kev Kho Mob CAR-T: Kev Nkag Siab Los Ntawm Xwm Kab Mob Cancer

Kev kho mob Chimeric Antigen Receptor (CAR)-T cell tau hloov pauv kev kho mob ntawm cov kab mob ntshav tsis zoo, muab kev cia siab rau cov neeg mob uas muaj cov kab mob tsis zoo. Txawm li cas los xij, cov teeb meem mus sij hawm ntev xws li kev kis kab mob thiab cov kab mob qog nqaij hlav thib ob tseem yog qhov kev txhawj xeeb tseem ceeb rau kev nyab xeeb, raws li tsab xov xwm tsis ntev los no hauv Mob Cancer Xwm.

Kev kho mob CAR-T thaum xub thawj tau txais kev pom zoo dav dav vim nws qhov ua tau zoo hauv kev sim tshuaj thiab kev siv hauv ntiaj teb tiag. Txawm hais tias cov teeb meem mob hnyav xws li cytokine release syndrome (CRS) thiab immune effector cell-associated neurotoxicity syndrome (ICANS) tau tswj tau nrog kev nce qib hauv kev saib xyuas txhawb nqa, cov kev tshuaj xyuas tsis ntev los no qhia txog qhov muaj ntau ntawm kev tuag tsis rov qab los (NRM) vim muaj kev kis kab mob thiab cov kab mob qog nqaij hlav thib ob ntawm cov neeg teb CAR-T.

Ib qho kev tshuaj xyuas meta-analysis uas muaj 7,604 lymphoma thiab Ntau yam mob myeloma cov neeg mob uas tau txais kev kho mob CAR-T tau qhia txog tus nqi NRM tag nrho ntawm 6.8%, sib txawv ntawm ntau yam kab mob thiab CAR-T cov qauv.Cov kab mob kis tau suav nrog feem ntau ntawm cov rooj plaub NRM, tsis muaj feem cuam tshuam nrog CAR-T Khoom nws tus kheej lossis tus kab mob hauv qab. Txawm hais tias muaj kev cuam tshuam loj heev ntawm COVID-19 thaum lub sijhawm kawm, cov kab mob bacterial thiab fungal txhua tus tau pab txhawb 20% ntawm kev tuag ntsig txog kev kis kab mob. Cov lej no sib piv rau cov uas tau pom tom qab autologous hematopoietic stem cell transplantation (auto-HSCT).

Yuav kom txo tau cov kev pheej hmoo no, cov kws tshawb fawb hais txog qhov siv tau ntawm cov cuab yeej kwv yees xws li qhov qhab nia CAR-HEMATOTOX, uas ntsuas cov yam xws li hematopoietic reserve thiab inflammatory baseline. Lub kaw lus qhab nia no pab txheeb xyuas cov neeg mob uas muaj kev pheej hmoo siab uas yuav tau txais txiaj ntsig los ntawm cov tshuaj tua kab mob prophylactic thiab kev saib xyuas kev tiv thaiv kab mob. Qhov tseem ceeb, kev ua xua rau cov hlwb tiv thaiv kab mob hnyav (ICAHT) muaj feem cuam tshuam nrog tus nqi NRM siab dua (14% piv rau 4.5% hauv cov xwm txheej tsis hnyav).

Cov kab mob qog nqaij hlav theem ob, suav nrog myelodysplastic syndromes (MDS), acute myeloid leukemia (AML), thiab carcinomas, yog lwm qhov teeb meem tseem ceeb. Cov mob qog nqaij hlav no feem ntau yog txuas nrog cov kev kho mob hnyav ua ntej xws li chemotherapy thiab auto-HSCT es tsis yog CAR-T cov khoom nws tus kheej. Clonal hematopoiesis, ib qho ua ntej rau kev kho mob MDS/AML, tau pom muaj txog li 56% ntawm cov neeg mob ua ntej CAR-T infusion.

Lub luag haujlwm ntawm kev kho mob CAR-T hauv cov kab mob qog no tseem raug tshawb nrhiav. Thaum cov xwm txheej ntawm CAR-T-induced T-Cell Lymphoma tau tshaj tawm lawm, qhov kev sib raug zoo tseem tsis paub meej. Hauv ib qho piv txwv tseem ceeb, cov qib CAR-RNA siab tau pom nyob rau hauv kev kho mob T-cell lymphoma tom qab CAR-T kho, tab sis kev tshuaj xyuas caj ces tau txiav txim siab tias CAR ntxig yog qhov tseem ceeb ntawm kev mob qog noj ntshav.

Cov Tswv Yim rau Kev Tswj Xyuas Kev Pheej Hmoo
Yuav kom ua tau zoo tshaj plaws rau qhov zoo thiab qhov txaus ntshai ntawm kev kho mob CAR-T, cov kws tshawb fawb pom zoo kom muaj kev kho mob thaum ntxov rau cov neeg mob uas muaj tsawg kab kev kho mob yav dhau los kom txo qis kev lom. Cov txheej txheem kwv yees qhov ntsuas thiab kev saib xyuas mus sij hawm ntev ntawm cov neeg tau txais CAR-T tuaj yeem txhim kho kev nyab xeeb ntxiv los ntawm kev ua kom pom tseeb thiab tswj hwm cov teeb meem thaum ntxov.

Tsab xov xwm no hais txog qhov tseem ceeb ntawm kev tshaj tawm txog cov teeb meem tsis zoo hauv kev sim tshuaj thiab cov ntawv sau npe, tshwj xeeb tshaj yog rau kev kis kab mob, mob qog noj ntshav theem ob, thiab NRM. Cov ntaub ntawv no yuav pab cov kws kho mob txhim kho cov txheej txheem kho mob thiab cov qauv xaiv neeg mob.

Xaus lus
Txawm hais tias kev kho mob CAR-T muaj peev xwm kho tau zoo rau cov kab mob ntshav tsis zoo, kev tswj hwm nws cov kev pheej hmoo mus sij hawm ntev yog qhov tseem ceeb heev. Kev tshawb fawb yav tom ntej yuav tsum tsom mus rau kev txhim kho cov cuab yeej kwv yees thiab tshawb nrhiav lwm txoj kev kho mob rau cov neeg laus lossis cov neeg mob tsis muaj zog uas tej zaum yuav tsis kam lees cov tshuaj lom CAR-T zoo.

Txoj haujlwm tshiab no ua rau peb nco txog qhov xav tau kev sib npaug ntawm kev ua haujlwm zoo thiab kev nyab xeeb hauv kev kho mob tshiab, kom ntseeg tau tias cov txiaj ntsig zoo tshaj plaws rau cov neeg mob thoob ntiaj teb.