Gukemura ibibazo by'igihe kirekire by'ubuvuzi bwa CAR-T: Ibisobanuro bivuye kuri Kanseri y'umwimerere

Ubuvuzi bwa Chimeric Antigen Receptor (CAR)-T cells bwahinduye uburyo bwo kuvura kanseri y'amaraso, bitanga icyizere ku barwayi bafite indwara zishobora kwangirika. Ariko, ingorane z'igihe kirekire nk'ubwandu n'izindi kanseri zikomeje kuba ikibazo gikomeye ku mutekano, nk'uko bigaragazwa n'ingingo iherutse gusohoka mu Kanseri y'ibidukikije.

Ubuvuzi bwa CAR-T bwatangiye gukoreshwa cyane bitewe n’ubushobozi bwabwo butangaje mu igeragezwa ry’ubuvuzi no mu bikorwa nyabyo. Nubwo uburozi bukabije nka cytokine release syndrome (CRS) na immuno effect cell-associated neurotoxicity syndrome (ICANS) byashoboye kugerwaho bitewe n’iterambere mu buvuzi bw’inyongera, isesengura riherutse rigaragaza ko impfu zitarasubira inyuma (NRM) ziterwa n’ubwandu n’izindi kanseri z’inyongera mu bashinzwe CAR-T.

Isesengura rya meta ririmo 7.604 lymphoma na Myeloma nyinshi Abarwayi bakorewe ubuvuzi bwa CAR-T bagaragaje ko igipimo rusange cya NRM cya 6.8%, gitandukanye mu ndwara zitandukanye n'imiterere ya CAR-T.Ubwandu bwagize uruhare runini mu ndwara za NRM, bidafite aho bihuriye n'ibyo Igicuruzwa cya CAR-T ubwabyo cyangwa indwara isanzwe. Nubwo COVID-19 yagize ingaruka zikomeye mu gihe cy'ubushakashatsi, ubwandu bwa bagiteri n'ibihumyo bwagize uruhare runini muri 20% by'impfu ziterwa n'ubwandu. Iyi mibare iragereranywa n'iyagaragaye nyuma yo gutera uturemangingo tw'amaraso mu maraso (auto-HSCT).

Kugira ngo bagabanye izi ngaruka, abashakashatsi bashimangira akamaro k'ibikoresho byo guhanura nka CAR-HEMATOTOX score, isuzuma ibintu nk'ibice byo mu maraso n'indwara yo mu ntangiriro. Ubu buryo bwo gupima bufasha mu kumenya abarwayi bafite ibyago byinshi bashobora kungukirwa na antibiyotike zigenewe kwirinda no kugenzura neza ubudahangarwa bw'umubiri. Ikigaragara ni uko uburozi buterwa n'uturemangingo buterwa n'ingaruka zikomeye ku ngirabuzimafatizo (ICAHT) bufitanye isano n'igipimo cyo hejuru cya NRM (14% ugereranyije na 4.5% mu bihe bitari bikomeye).

Indwara za kanseri zo mu bwoko bwa kabiri, harimo indwara za myelodysplastic syndrome (MDS), kanseri y’imitsi ikabije (AML), na kanseri, ni ikindi kibazo gikomeye. Izi ndwara za kanseri zifitanye isano cyane cyane n’ubuvuzi bwa kera bukabije nka chemotherapy na auto-HSCT aho kuba umuti wa CAR-T ubwawo. Indwara ya hematopoiesis ya Clonal, ibanziriza MDS/AML ijyanye n’ubuvuzi, yagaragaye ku barwayi bagera kuri 56% mbere yo guterwa CAR-T.

Uruhare rw'ubuvuzi bwa CAR-T muri izi ndwara za kanseri ruracyari gukorwaho iperereza. Mu gihe imanza za CAR-T ziterwa na Lymphoma ya T-cell Byatangajwe ko isano iri hagati y’impamvu itaramenyekana neza. Hari igihe kimwe cyagaragaye ko urugero rwa CAR-RNA ruri hejuru rwagaragaye mu buvuzi bwa T-cell lymphoma nyuma ya CAR-T, ariko isesengura rya genetiki ryagaragaje ko gushyira CAR mu mubiri ari byo bintu by’ingenzi bitera kanseri.

Ingamba zo gucunga ingaruka
Kugira ngo ubuvuzi bwa CAR-T burusheho kugira ingaruka ku nyungu n'ingaruka, abashakashatsi basaba abarwayi bafite uburyo buke bwo kuvurwa mbere kugira ngo bagabanye uburozi. Uburyo bwo gutanga amanota no gukurikirana abahawe CAR-T mu gihe kirekire bishobora kongera umutekano binyuze mu gutuma haboneka ingaruka hakiri kare.

Iyi nkuru ishimangira akamaro ko gutanga raporo yuzuye y’ingaruka mbi mu igeragezwa ry’ubuvuzi no mu bitabo by’ibarurishamibare, cyane cyane ku ndwara zandurira mu burwayi, kanseri y’inyongera, na NRM. Ayo makuru azafasha abaganga kunoza amabwiriza agenga uburyo bwo kuvura no guhitamo abarwayi.

Umwanzuro
Nubwo ubuvuzi bwa CAR-T butanga ubushobozi budasanzwe bwo kuvura kanseri y’amaraso, gucunga ibyago byayo by’igihe kirekire ni ingenzi cyane. Ubushakashatsi bw’igihe kizaza bugomba kwibanda ku kunoza uburyo bwo guhanura no gushakisha ubundi buryo bwo kuvura abarwayi bakuze cyangwa bafite intege nke bashobora kutihanganira uburozi buterwa na CAR-T neza.

Uyu murimo w’ingenzi utwibutsa ko hakenewe kuringaniza imikorere n’umutekano mu buvuzi bushya, kugira ngo abarwayi ku isi yose babone umusaruro mwiza.