Kupita Patsogolo Pamaphunziro | Gulu la Zachipatala la Lu Daopei Lafalitsa Kafukufuku Wachipatala Wodabwitsa mu British Journal of Haematology

Mu kupambana kwakukulu kwa Gulu la Zachipatala la Lu Daopei, pepala lofufuzira zachipatala lotchedwa "Kafukufuku wokhudza chitetezo ndi mphamvu ya allogeneic haematopoietic stem cell transplantation kwa odwala omwe adachira komanso omwe adabwereranso ku T-cell acute lymphoblastic leukaemia/lymphoblastic lymphoma omwe adachira kwathunthu pambuyo pa chithandizo cha autologous CD7 chimeric antigen receptor T-cell" yafalitsidwa mu buku lodziwika bwino la Nyuzipepala ya ku Britain ya Hematology (IF=5.1). Kafukufukuyu, wolembedwa ndi Dr. Cao Xingyu ndi Pulofesa Lu Peihua ngati wolemba wofanana, akuyang'ana kwambiri kuthekera kothandiza kogwirizanitsa odwala allo-HSCT a R/R T-ALL ndi T-LBL omwe adapeza chikhululukiro chathunthu (CR) pambuyo pa chithandizo cha autologous CD7 CAR-T.

Mbiri Yofufuzira:

Matenda a khansa a T-cell, monga T-ALL ndi T-LBL, amadziwika kuti ndi amphamvu komanso osalandira chithandizo chokwanira. Kwa odwala omwe ali ndi T-ALL/LBL (R/R T-ALL/T-LBL) omwe ali ndi vuto losagwira ntchito kapena omwe abwereranso kuchipatala, njira zochiritsira zachikhalidwe sizithandiza kwenikweni komanso sizimapereka chiyembekezo chabwino. Komabe, chithandizo cha CD7 CAR-T chakhala ngati njira yabwino yopititsira patsogolo chithandizo, chomwe chikuwonetsa chiyembekezo chachikulu pochiza matenda ovuta awa, ngakhale kuti akadali kumayambiriro kwa mayeso azachipatala. Pambuyo potsatira kuphatikiza ndi allo-HSCT, odwala omwe amalandira CR ndi chithandizo cha CD7 CAR-T amapatsidwa mwayi weniweni wochira kwa nthawi yayitali.

Njira Yophunzirira:

Kafukufuku wobwerera m'mbuyoyu adafufuza odwala a R/R T-ALL ndi T-LBL omwe adalandira chithandizo cha NS7 CAR-T, kenako adaphatikizana ndi allo-HSCT pakati pa Novembala 2020 ndi Januwale 2023 ku Lu Daopei Hospital. Kafukufukuyu adafufuza zinthu zosiyanasiyana, kuphatikizapo zaka za wodwala, nambala ya maselo a CAR-T asanaikidwe, ndi njira zosiyanasiyana zoperekera mankhwala a CAR-T, kuti awone momwe zimakhudzira zotsatira za kuikidwa kwa maselo ena. Zotsatira zake zidayerekezeredwa ndi za odwala 124 omwe adapeza CR kudzera mu chemotherapy otsatiridwa ndi allo-HSCT.

Zomwe Zapezeka:

Kafukufukuyu adaphatikizapo odwala 34 a R/R T-ALL/T-LBL omwe adapeza CR atalandira chithandizo cha NS7 CAR-T ndipo pambuyo pake adapatsidwa allo-HSCT. Nthawi yapakati pakati pa chithandizo cha CAR-T ndi kumuika munthu wina inali masiku 57.5. Chodziwika bwino n'chakuti, 47.1% ya odwala anali ndi matenda oyamba oletsa kuchira, pomwe 52.9% anali ndi matenda obwereranso. Pambuyo pa kulowetsedwa kwa CAR-T, cytokine release syndrome (CRS) idachitika mwa odwala 33, ndipo 94.1% anali ndi CRS ya Giredi 1-2. Mwamwayi, palibe odwala omwe adadwala immunoeffector cell-associated neurotoxicity syndrome (ICANS).

Patatha masiku 28 kuchokera pamene CAR-T inayamba, odwala 31 anapeza MRD-negative CR, pomwe odwala atatu anali ndi MRD-positive CR. Kafukufukuyu adapezanso kuti odwala omwe anali ndi ≤20% ya kuphulika kwa mafupa asanaikidwe anali ndi chiŵerengero chobwereranso cha 0% pa miyezi 18 pambuyo poti aikidwe. Poyerekeza ndi odwala omwe anali ndi chemotherapy-based CR, chiŵerengero cha moyo wonse wa zaka ziwiri (OS) chinali chofanana: 61.9% ya gulu la CD7 CAR-T poyerekeza ndi 67.6% ya gulu la chemotherapy. Kuphatikiza apo, chiŵerengero cha moyo wopanda leukemia wa zaka ziwiri (LFS) chinali chofanana (62.3% poyerekeza ndi 62.0%).

Chodziwika bwino ndi chakuti, odwala azaka zoposa 14 omwe adalandira chithandizo cha CD7 CAR-T anali ndi 87.5% OS ndi LFS ya zaka ziwiri. Zotsatira zake zikusonyeza kuti chithandizo cha CD7 CAR-T chotsatiridwa ndi allo-HSCT chingapereke njira ina yotetezeka komanso yothandiza kwa odwala a R/R T-ALL/T-LBL omwe sakuyenerera kulandira chithandizo chachikhalidwe.

Mapeto:

Kafukufukuyu akutsimikiza kuti kuphatikiza chithandizo cha CD7 CAR-T chotsatiridwa ndi allo-HSCT kumapereka njira yothandiza komanso yothandiza yothandizira odwala a R/R T-ALL/T-LBL. Zotsatira zake zinali zofanana ndi zomwe zidapezeka ndi chemotherapy ndi allo-HSCT, popanda kuwonjezeka kwa imfa zomwe sizingabwererenso m'mbuyo, zomwe zimapereka njira yothandiza kwambiri yothandizira odwala omwe ali ndi njira zochepa zochiritsira. Zomwe zapezeka mu kafukufukuyu zimapereka chiyembekezo cha kuchira kwa nthawi yayitali komanso kupulumuka, makamaka kwa odwala omwe ali pachiwopsezo chachikulu omwe amathandizidwa ndi allo-HSCT nthawi yake.

Zotsatira ndi Chiyembekezo cha Mtsogolo:

Kufalitsidwa kwa kafukufuku wofunikira uyu mu Nyuzipepala ya ku Britain ya Hematologyndi umboni wa kudzipereka ndi luso la Gulu la Zachipatala la Lu Daopei. Kupambana kumeneku kukuwonetsa khama lomwe chipatalachi chikuchita popititsa patsogolo chithandizo cha matenda a magazi komanso zopereka zawo zofunika kwambiri kwa madokotala padziko lonse lapansi. Kukuwonetsa kuthekera kwa chithandizo cha CD7 CAR-T ngati njira yabwino kwa odwala omwe ali ndi R/R T-ALL/T-LBL ndipo kukuwonetsa kudzipereka kwa gululo kukankhira malire a hematological. Chithandizo cha Khansa.