Ubuvuzi bwa CAR-T bwatsinze ikibazo cyo kurwara Lymphoma yo mu bwoko bwa B-cell classified nabi
Ubushakashatsi buherutse gusohoka muri Iterambere ry'Amarasobigaragaza ko ubuvuzi bwa CAR-T butanga inyungu zikomeye ku barwayi bafite uburwayi bwo mu rwego rwo hejuru Lymphoma y'uturemangingo twa B (HGBL), ubwoko bukomeye cyane bwa lymphoma nini ya B-cell (LBCL). Ubushakashatsi bwa DESCAR-T LYSA, bwakozwe n'abashakashatsi b'Abafaransa, bwibanze ku barwayi bahawe ubuvuzi bwa CAR-T nk'ubuvuzi bwo ku rwego rwa gatatu cyangwa nyuma yabwo, harimo n'abafite MYC na BCL2 na/cyangwa BCL6 rerrangements—bizwi nka lymphoma "double-hit" cyangwa "triple-hit".
Ubushakashatsi bwakorewe ku barwayi 228 bo mu kigo cy’Abafaransa cya DESCAR-T, muri bo 73 bagaragayeho HGBL, mu gihe abandi 155 bari bafite LBCL itari HGBL. Ubu bushakashatsi bwari bugamije gusuzuma umutekano n’ubushobozi bw’ubuvuzi bwa CAR-T muri ayo matsinda, aho igihe cyo gukurikirana ikigereranyo cy’amezi 18.5 cyagenwe.
Ibyavuye mu bushakashatsi byagaragaje ko igipimo rusange cy’ubwitabire (ORR) n’igipimo cyuzuye cy’ubwitabire (CR) byari bingana hagati y’abarwayi ba HGBL n’abatari aba HGBL, kuri 68% na 60% kuri HGBL, na 76% na 59% ku batari aba HGBL, uko bikurikirana (p=0.293 na p=0.923). Byongeye kandi, ikigereranyo cy’ubuzima budafite iterambere (PFS) ku barwayi ba HGBL cyari amezi 3.2, ugereranije n’amezi 4.5 ku barwayi batari aba HGBL, nubwo iri tandukaniro ritari rifite agaciro gakomeye mu mibare (p=0.103). Mu buryo nk’ubwo, ikigereranyo rusange cy’ubuzima (OS) cyari amezi 15.4 ku barwayi ba HGBL ugereranyije n’amezi 18.3 ku barwayi batari aba HGBL (p=0.214).
Igishimishije ni uko igihe OS yabarwaga uhereye igihe abarwayi bemerewe kuvurwa na CAR-T, ikigereranyo cy’imikorere y’umubiri ku barwayi ba HGBL cyagabanutse kigera ku mezi 7.6, ugereranije n’amezi 11.8 ku barwayi batari aba HGBL (p=0.062), bigaragaza ko igihe cyo gutanga CAR-T bigira uruhare runini mu kunoza umusaruro.
Mu bwoko butandukanye bwa HGBL, abafite MYC-BCL2 double-hit lymphoma bagize ingaruka mbi cyane, aho ikigereranyo cya OS cyamaze amezi 6.6 gusa, kiri hasi cyane ugereranyije n'izindi nkomoko za HGBL (HGBL-DH MYC-BCL6: amezi 13.6, HGBL-NOS: amezi 18.5) n'abarwayi batari aba HGBL (amezi 11.8). Nubwo bimeze bityo, nta tandukaniro rigaragara muri OS cyangwa PFS ryabonetse mu kugereranya igihe cyo guterwa CAR-T.
Umutekano w'ubuvuzi bwa CAR-T wari uhoraho ku matsinda ya HGBL n'atari aya HGBL. Kuba hariho indwara ya cytokine release syndrome (CRS) na immuno effect cell-associated neurotoxicity syndrome (ICANS) byari bisa hagati y'ayo matsinda yombi. Ariko, 38% by'abarwayi ba HGBL bakeneraga ubuvuzi bwa ICU kuri CRS, nubwo ibi byari bigereranywa n'ibisabwa mu buvuzi biboneka ku barwayi batari aba HGBL.
Inyigo ya DESCAR-T LYSA igaragaza ubushobozi bwa CAR-T mu kunoza imiterere y’abarwayi ba HGBL, ndetse no mu nzira zo kuvurwa nyuma. Nubwo CAR-T ishobora kudatsinda burundu imiterere mibi ijyanye n’ubwoko bumwe na bumwe bw’indwara zishobora gutera ibyago byinshi, nka HGBL yakubiswe kabiri, inyigo ishishikariza abantu gufata ingamba hakiri kare hakoreshejwe CAR-T therapy, ishobora gutanga umusaruro mwiza wo kubaho. Byongeye kandi, kugabanya igihe kiri hagati ya leukapheresis no guterwa CAR-T bishobora kuba ingenzi ku barwayi bafite indwara zikomeye nka HGBL.
Ubu bushakashatsi bugaragaza akamaro k'ubuvuzi bwa CAR-T nk'uburyo bwiza bwo kuvura lymphoma yo mu rwego rwo hejuru ya B-cell lymphoma, kandi butanga ubumenyi bw'ingirakamaro mu kunoza igihe cyo kuvura kugira ngo umurwayi agire umusaruro mwiza. Hakenewe ubundi bushakashatsi kugira ngo hasuzumwe uburyo bwo kongera imikorere y'ubuvuzi bwa CAR-T, cyane cyane mu bwoko bwa lymphoma bugoye.