Kupindira Kwekutanga neCAR-T Therapy yeB-Cell Lymphoma Yakakura Kunoratidza Mhedzisiro Inofadza
Chidzidzo chekare chakabudiswa munguva pfupi yapfuura mu Kudyarwa kweBone Morrowyakaongorora kushanda kwekurapa kweCAR-T cell therapy nekukurumidza kana kunonoka muvarwere vane chirwere chikuru. B-Cell Lymphoma (LBCL). Chidzidzo ichi chakaitwa munzvimbo nhatu muUS neIsrael, chaisanganisira varwere 354 vakarapwa neCD19-targeted CAR-T therapy pakati paKubvumbi 2016 naKurume 2024. Chinangwa chekudzidza ichi ndechekuongorora kukanganisa kwekupa CAR-T therapy sekurapa kwechipiri (kurapwa kwekutanga) zvichienzaniswa nekurapa kwechitatu kana kuti gare gare (kurapwa kunonoka) kune LBCL yakadzoka kana kuti isingashande.
Zvakabuda zvakaratidza kuti kurapwa kweCAR-T kwakatanga, zvichipiwa nepo mutoro wegomarara remurwere wakaderera uye nzvimbo yekudzivirira muviri iri nani, kwaive nemigumisiro yakanaka. Huwandu hwemhinduro mushure megore rimwe hwaive 87% yekurapwa nekukurumidza uye 82% yekurapwa nekukurumidza, kunyangwe musiyano wacho waive usina kukosha (p=0.3). Zvisinei, huwandu hwekurarama (OS) hwaive hwakakwira kune boka rekurapwa nekukurumidza, ne82% yekurarama mugore rimwe chete zvichienzaniswa ne71% yeboka rekurapwa nekukurumidza (p=0.048).
Zvinofadza kuti chidzidzo ichi hachina kuwana mutsauko mukuru pakati pemapoka maviri aya mukurarama kusina progressive-free survival (PFS), kudzoka kwechirwere, kana kufa kwakabatana nekurapwa. Kudzoka kwechirwere kwegore rimwe chete kwaive 37% kune boka rekutanga uye 43% kune boka rapera, pasina kukanganisa kwakakosha kubva panguva yekupa CAR-T (p=0.2). Chidzidzo ichi chakawanawo kuti kuwanda kwe cytokine release syndrome (CRS) yegiredhi rechipiri kana kupfuura kwaive kwakaderera zvakanyanya muboka rekutanga rekurapwa (26%) zvichienzaniswa neboka rekupedzisira rekurapwa (39%) (p=0.031), zvichiratidza kuti kupindira kwekutanga kunogona kuderedza zvimwe zvinhu zvine chekuita nekurapwa.
Zvakawanikwa izvi zvinotsigira kushandiswa kwemishonga yeCAR-T senzira yechipiri yekurapa LBCL, sezvo ichigona kudzivirira matambudziko ane chekuita nekurapwa kwechikamu chinotevera, kusanganisira kudzikira kwekutsungirira nekuda kwehutano hwemurwere kana kuneta kwemasero eT. Chidzidzo ichi chinosimbisawo kudiwa kwekutsvaga kwakawanda kuti tinzwisise mashandiro emuviri ekurapwa kweCAR-T uye kutsvaga mishonga inogona kusanganiswa kuti ivandudze mhedzisiro mumatanho ese ekurapwa.
Kunyange zvazvo chidzidzo ichi chiri chekuongorora zvakaitika kare uye chingave chine rusaruro uye kuteverwa kushoma, mhedzisiro yacho inopa ruzivo rwakakosha nezvenguva yakakodzera yekurapa kweCAR-T muvarwere veLBCL. Zvakawanikwa zvinoratidza kuti kupindira nekukurumidza neCAR-T therapy kunogona kuvandudza kurarama uye kuderedza chepfu, zvichipa danho rakakosha mukuvandudza nzira dzekurapa kenza iyi yakaoma.