Kugadzirisa Matambudziko Enguva Refu Ekurapa kweCAR-T: Ruzivo Kubva kuCancer Yezvisikwa

Kurapa nemasero eChimeric Antigen Receptor (CAR)-T kwakachinja kurapwa kwezvirwere zveropa., zvichipa tariro kuvarwere vane zvirwere zvisingadi kurapwa. Zvisinei, matambudziko enguva refu akadai sehutachiona uye kenza yechipiri ichiri chinhu chakakosha chekuchengetedzeka, sekureva kwechinyorwa chazvino mu Kenza yezvisikwa.

Kurapa kweCAR-T kwakatanga kushandiswa zvakanyanya nekuda kwekushanda kwayo kunoshamisa mukuyedzwa kwekiriniki uye kushandiswa kwayo chaiko. Kunyange hazvo hutachiona hwakadai secytokine release syndrome (CRS) uye immune effector cell-associated neurotoxicity syndrome (ICANS) zvave nyore kushandisa nekufambira mberi mukurapa kwekutsigira, ongororo dzichangoburwa dzinoratidza kuwanda kwekufa kusingadzokeri shure (NRM) nekuda kwehutachiona uye kenza yechipiri pakati pevanopindura kuCAR-T.

Kuongorora kwakadzama kunosanganisira 7,604 lymphoma uye Multiple Myeloma Varwere vakarapwa neCAR-T vakaratidza kuti huwandu hweNRM hwe6.8%, hwakasiyana zvichienderana nezvirwere zvakasiyana uye mafomu eCAR-T.Utachiona hwakakonzera ruzhinji rwezvirwere zveNRM, isina chekuita ne Chigadzirwa cheCAR-T iyo pachayo kana chirwere chiripo. Pasinei nekukanganiswa kukuru kweCOVID-19 panguva yekudzidza, hutachiona hwemabhakitiriya nefungus chimwe nechimwe chakakonzera 20% yerufu rwakakonzerwa nehutachiona. Nhamba idzi dzakafanana nedzakaonekwa mushure mekuisirwa kwemasero eropa (auto-HSCT).

Kuti vaderedze njodzi idzi, vaongorori vanosimbisa kushandiswa kwezvishandiso zvekufanotaura zvakaita seCAR-HEMATOTOX score, iyo inoongorora zvinhu zvakaita se hematopoietic reserve uye baseline inflammation. Iyi scoring system inobatsira mukuona varwere vane njodzi huru vanogona kubatsirwa nemishonga inorwisa mabhakitiriya yakagadzirirwa kudzivirira uye kutarisa immune system zvakanaka. Zvinonyanya kukosha kuti, severe immune effect cell-associated hematotoxicity (ICAHT) yakabatana neNRM rate yakakwira (14% zvichienzaniswa ne4.5% muzviitiko zvisina kuoma).

Zvirwere zvegomarara rechipiri, zvinosanganisira myelodysplastic syndromes (MDS), acute myeloid leukemia (AML), uye carcinomas, zvinomirira chimwe chinhu chakakosha. Maronda aya anonyanya kusanganiswa nekurapwa kwakasimba kwakaitwa kare kwakadai sechemotherapy uye auto-HSCT pane mushonga weCAR-T pachawo. Kubuda kweropa muropa kweClonal, iyo inotangira MDS/AML ine chekuita nekurapa, yakaonekwa muvarwere vanosvika 56% vasati vapihwa CAR-T.

Basa rekurapa neCAR-T muzvirwere izvi zvegomarara richiri kuferefetwa. Kunyange hazvo nyaya dzeCAR-T dzakakonzereswa nechirwere ichi. T-Cell Lymphoma Zvakataurwa kuti pane hukama hwacho huchiripo. Mune imwe nyaya inokosha, huwandu hwakakwira hweCAR-RNA hwakaonekwa mukurapwa kweT-cell lymphoma mushure meCAR-T, asi ongororo yemajini yakaratidza kuti kuiswa kweCAR ndicho chinhu chikuru chinokonzera chirwere chegomarara.

Maitiro Ekugadzirisa Njodzi
Kuti vagadzirise njodzi yekurapa kweCAR-T, vaongorori vanokurudzira kupindira nekukurumidza muvarwere vane nzira shoma dzekurapa dzakamboshandiswa kuderedza chepfu. Maitiro ekufungidzira uye kuteverwa kwenguva refu kwevanogamuchira CAR-T zvinogona kuwedzera kuchengetedzeka nekuita kuti zvikwanisike kuona nekukurumidza uye kutarisira matambudziko.

Nyaya iyi inosimbisa kukosha kwekunyora mishumo yakazara yezviitiko zvakaipa mumiedzo yekiriniki uye munzvimbo dzekunyoresa, kunyanya yezvirwere, kenza yechipiri, uye NRM. Ruzivo rwakadaro ruchabatsira vanachiremba kunatsiridza nzira dzekurapa uye zvinodiwa pakusarudzwa kwevarwere.

Mhedziso
Kunyange hazvo kurapwa kweCAR-T kuchipa mukana wekurapa unoshamisa wezvirwere zveropa, kugadzirisa njodzi dzayo dzenguva refu kwakakosha. Tsvagiridzo yeramangwana inofanira kutarisa pakuvandudza maturusi ekufanotaura uye kutsvaga dzimwe nzira dzekurapa varwere vakwegura kana vasina simba vangave vasingashiviriri zvakanaka chepfu dzine chekuita neCAR-T.

Basa iri guru rinoratidza kukosha kuripo kwekuenzanisa kushanda zvakanaka uye kuchengetedzeka mukurapa kutsva, zvichiita kuti varwere vawane mhedzisiro yakanaka pasi rose.