CAR-T ya Systemic Lupus Erythematosus (SLE)

Ms.C ndi wodwala amene walandira chithandizo chabwino cha SLE kudzera mu CAR-T therapy. Nayi nkhani yake.

Chidule cha Nkhaniyi:

Mayi C, mayi wazaka 32, wakhala akuvutika ndi matenda a systemic lupus erythematosus (SLE) kwa zaka ziwiri. Ngakhale kuti adalandira chithandizo chamankhwala chachikhalidwe, vuto lake silinathe. Anali ndi zizindikiro zoopsa, kuphatikizapo nephritis, kupweteka kwa mafupa, ndi ziphuphu zosalekeza, zomwe zinakhudza kwambiri moyo wake.

Mkhalidwe Wosalandira chithandizo:

Matenda a Ms. C's SLE anali ndi zizindikiro zoopsa, kuphatikizapo kupweteka kwa mafupa, nephritis yobwerezabwereza, ndi ziphuphu zosatha. Mayeso a labotale adawonetsa ma antibodies a DNA okhala ndi ma stranded awiri komanso kuchepa kwa C3 ndi C4, zomwe zimasonyeza matenda omwe ali nawo. Ndi Systemic Lupus Erythematosus Disease Activity Index (SLEDAI-2K) score ya 16, matenda a Ms. C adawonedwa ngati ovuta kwambiri, ndipo mankhwala wamba oletsa chitetezo chamthupi sanathandize.

Chisankho cha Chithandizo cha CAR-T:

Popeza matenda ake sanathe kuchira, Mayi C adalembetsa mu mayeso azachipatala a chithandizo cha maselo a CAR-T—mankhwala atsopano omwe adapangidwa kale kuti athetse khansa zina, koma tsopano akufufuzidwa matenda odziteteza okha monga SLE. Chithandizo cha CAR-T chimagwira ntchito popanga maselo a T a wodwalayo kuti azitha kuyang'ana maselo enaake a chitetezo chamthupi omwe amatenga gawo lofunikira pa matendawa.

Njira Yochizira CAR-T:

1. Kusankha Wodwala: Matenda a Ms. C a SLE amphamvu komanso osagwira ntchito bwino adamupangitsa kukhala woyenera kulandira chithandizo cha CAR-T.

2. Kukonzekera: Asanalandire maselo a CAR-T, Mayi C adapatsidwa chithandizo cha chemotherapy, njira yodziwika bwino yochepetsera kuchuluka kwa ma lymphocyte omwe analipo kale ndikukonzekeretsa chitetezo cha mthupi chawo kuti chilandire chithandizo cha CAR-T.

3. Uinjiniya wa T-cell: Maselo a T a Ms. C adasonkhanitsidwa ndi kusinthidwa mu labu kuti awonetse ma receptor a chimeric antigen (CAR) omwe amayang'ana ma antigen a CD19 ndi BCMA. Ma antigen awa amapezeka kwambiri pamwamba pa maselo a B, omwe amagwira ntchito yofunika kwambiri pakugwira ntchito kwa chitetezo chamthupi komwe kumawonedwa mu SLE.

4. Kulowetsedwa kwa Maselo a CAR-T: Pambuyo pokulitsa ndi kuyesa ubwino, maselo a CAR-T osinthidwawo anabwezeretsedwanso m'thupi la Ms. C. Kulowetsedwa kumeneku kunayambitsa mutu watsopano pankhondo yake yolimbana ndi lupus.

5. Kuyang'anira Odwala Ogonekedwa: Mayi C anayang'aniridwa mosamala kwa masiku 25 atatha kumwa mankhwalawa kuti atsimikizire kuti mankhwalawa ndi otetezeka komanso ogwira ntchito. Ogwira ntchito zachipatala ankayang'anitsitsa zizindikiro zilizonse zoyipa, monga cytokine release syndrome (CRS), yomwe imachitika kawirikawiri ndi chithandizo cha CAR-T.

Zotsatira za Chithandizo:

1. Yankho la Nthawi Yaifupi: Mkati mwa milungu itatu yokha atalandira mankhwala, Mayi C adawona kusintha kwakukulu kwa zizindikiro zake. Kupweteka kwa mafupa ndi kutupa kwake kunachepa, ndipo ziphuphu zomwe zinkamuvutitsa kwa zaka zambiri zinayamba kutha. Mayeso a labu adawonetsanso kuti maselo a B m'magazi mwake adachotsedwa bwino, zomwe zimatsimikizira kuti maselo a CAR-T adalimbana bwino ndi zigawo zomwe chitetezo cha mthupi chake sichikugwira ntchito bwino.

2. Kuwunika kwa Pakati pa Nthawi (Miyezi 3): Pa miyezi itatu, matenda a Ms. C anali ochepa kwambiri, ndipo chiŵerengero chake cha SLEDAI-2K chinatsika kuchoka pa 16 kufika pa 2. Matenda ake a nephritis, omwe anali ovuta kwambiri asanalandire chithandizo, tsopano anali pansi pa ulamuliro, ndipo proteinuria yake inachepa kwambiri. Kuphatikiza apo, kuchuluka kwa ma antibodies a DNA omwe anali ndi ma stranded stranded kunachepa, ndipo kuchuluka kwa C3 ndi C4 komwe anali nako kunabwerera mwakale, kusonyeza kuti chitetezo chamthupi chayambanso kugwira ntchito.

3. Zotsatira Zanthawi Yaitali (Miyezi 12): Chaka chimodzi atalandira chithandizo cha CAR-T, Mayi C anakhalabe opanda mankhwala ndipo palibe zizindikiro za kubwereranso kwa SLE. Chitetezo cha mthupi chake chinayamba kuchira pang'onopang'ono, ndipo ngakhale maselo ake a B adabwereranso, sanawonetse vuto lililonse. Kupatula kukhala ndi CRS yochepa, Mayi C sanakumane ndi zotsatirapo zoyipa panthawi yonse ya chithandizo.

Zambiri zokhudza chithandizo:

Chithandizo cha CAR-T chawonetsa chiyembekezo chachikulu pochiza matenda a systemic lupus erythematosus (SLE), makamaka kwa odwala omwe ali ndi matenda oopsa komanso osachiritsika. Kafukufuku waposachedwapa akuwonetsa kuti amagwira ntchito bwino, ndipo odwala ambiri amachira popanda mankhwala kwa nthawi yayitali.

Mu kafukufuku wokhudza odwala asanu ndi atatu, onse adawonetsa kuti matenda atha kwathunthu atalandira chithandizo cha maselo a CAR-T cholunjika ku maselo a B omwe ali ndi CD19. Chithandizochi chinapangitsa kuti maselo a B awa achepe, omwe amachititsa kuti ma autoantibodies owopsa a SLE apangidwenso. Chofunika kwambiri, ngakhale maselo a B atangobadwanso, matendawa sanabwererenso, ndipo odwalawo adatha kukhalabe ndi chitetezo chamthupi choyankha katemera. Izi zikusonyeza kuti chithandizo cha CAR-T chimakhala cholimba kwambiri pa chitetezo chamthupi, makamaka poletsa kuukira kwa SLE komwe kumachitika chifukwa cha chitetezo chamthupi.

Kafukufuku wofufuza odwala omwe adatenga miyezi 13 adawonetsa kuti onse omwe adachita nawo kafukufukuyu adachepetsa kwambiri kuchuluka kwa matenda, ndipo palibe kubwereranso komwe kudawonedwa. Kuphatikiza apo, chithandizochi nthawi zambiri chinali chololedwa bwino, ndipo zotsatirapo zochepa monga cytokine release syndrome (CRS) zinali zodalirika.

Zotsatira zabwinozi zikusonyeza kuti chithandizo cha CAR-T chingapereke yankho lothandiza komanso la nthawi yayitali kwa odwala omwe ali ndi SLE yosagwira ntchito, zomwe zingachotse kufunikira kwa chithandizo cha chitetezo chamthupi kwa moyo wawo wonse.