Impumelelo Yezemfundo | Ithimba Lezokwelapha laseLu Daopei Lishicilela Ucwaningo Lwezokwelapha Oluyingqopha-mlando ku-British Journal of Haematology

Empumelelweni ebalulekile yeQembu Lezokwelapha laseLu Daopei, iphepha locwaningo lwezokwelapha eliqavile elinesihloko esithi "Ucwaningo lokuphepha nokusebenza kahle kokufakelwa kwamaseli e-stem e-allogeneic haematopoietic kweziguli ze-T-cell acute lymphoblastic leukaemia/lymphoblastic lymphoma eziphinde zathola ukuthethelelwa okuphelele ngemuva kokwelashwa kwe-T-cell ye-autologous CD7 chimeric antigen receptor" ishicilelwe encwadini edumile Ijenali YaseBrithani Ye-Haematology (IF=5.1). Ucwaningo, olubhalwe nguDkt. Cao Xingyu kanye noSolwazi Lu Peihua njengombhali ohambisanayo, lugxile emandleni athembisayo okuhlanganisa iziguli ze-R/R T-ALL kanye ne-T-LBL ezithole ukuxolelwa okuphelele (CR) ngemuva kokwelashwa kwe-CD7 CAR-T nge-autologous.

Isizinda Socwaningo:

Umdlavuza we-T-cell, njenge-T-ALL kanye ne-T-LBL, waziwa ngokuba nolaka kanye nokumelana kwawo nokwelashwa okuphezulu. Ezigulini ezine-T-ALL/LBL (R/R T-ALL/T-LBL) engaphikisi noma ephinde yabuyela emuva, izindlela zokwelapha zendabuko zinikeza impumelelo elinganiselwe kanye nezibikezelo ezimbi. Kodwa-ke, ukwelashwa kwe-CD7 CAR-T kuvele njengempumelelo engaba khona, okubonisa ithemba elikhulu ekwelapheni lezi zimo ezinzima ukwelapha, naphezu kokuthi kusesezigabeni zokuqala zokuhlolwa kwemitholampilo. Uma kulandelwa ukuhlanganiswa ne-allo-HSCT, iziguli ezithola i-CR ngokwelashwa kwe-CD7 CAR-T zinikezwa ithuba langempela lokuphumula isikhathi eside.

Indlela Yokufunda:

Lolu cwaningo olubukezwa emuva luhlaziye iziguli ze-R/R T-ALL kanye ne-T-LBL ezathola ukwelashwa kwe-NS7 CAR-T, kwalandela ukuhlanganiswa kwe-allo-HSCT phakathi kukaNovemba 2020 noJanuwari 2023 eSibhedlela iLu Daopei. Ucwaningo luhlole izici ezahlukahlukene, okuhlanganisa iminyaka yesiguli, inombolo yekhophi yeseli le-CAR-T ngaphambi kokufakelwa, kanye nezindlela ezahlukene zokulinganisa i-CAR-T, ukuze kuhlolwe umthelela wazo emiphumeleni yokufakelwa. Imiphumela iqhathaniswe neyeziguli ezingu-124 ezithole i-CR nge-chemotherapy elandelwa yi-allo-HSCT.

Okutholakele Okubalulekile:

Ucwaningo luhlanganise iziguli ezingu-34 ze-R/R T-ALL/T-LBL ezithole i-CR ngemuva kokwelashwa nge-NS7 CAR-T futhi kamuva zenza i-allo-HSCT. Isikhathi esimaphakathi phakathi kokwelashwa nge-CAR-T nokufakelwa kwamathambo sasiyizinsuku ezingu-57.5. Okuphawulekayo ukuthi, u-47.1% weziguli wayenesifo esiyinhloko sokungalapheki, kanti u-52.9% wayenesifo esiphinde sabuya. Ukufakwa kwe-cytokine release syndrome (CRS) ngemuva kwe-CAR-T kwenzeka ezigulini ezingu-33, kanti u-94.1% wayene-CRS yeBanga 1-2. Ngenhlanhla, azikho iziguli ezathola i-immune effector cell-associated neurotoxicity syndrome (ICANS).

Ezinsukwini ezingama-28 ngemuva kwe-CAR-T, iziguli ezingu-31 zithole i-MRD-negative CR, kanti iziguli ezintathu zine-MRD-positive CR. Ucwaningo luphinde lwathola ukuthi iziguli ezine-≤20% yokuqhuma komnkantsha ngaphambi kokufakelwa zazinezinga lokubuyela emuva elingu-0% ezinyangeni ezingu-18 ngemuva kokufakelwa. Uma kuqhathaniswa neziguli ze-CR ezisekelwe ku-chemotherapy, amazinga okusinda (OS) eminyaka emibili ayefana: 61.9% eqenjini le-CD7 CAR-T vs. 67.6% eqenjini le-chemotherapy. Ngaphezu kwalokho, amazinga okusinda okungenalo i-leukemia (LFS) yeminyaka emibili ayecishe afanane (62.3% vs. 62.0%).

Okuphawulekayo ukuthi iziguli ezineminyaka engu-≤14 ubudala ezathola ukwelashwa kwe-CD7 CAR-T zazine-OS ne-LFS yeminyaka emi-2 evelele engu-87.5%. Imiphumela isikisela ukuthi ukwelashwa kwe-CD7 CAR-T okulandelwa yi-allo-HSCT kunganikeza enye indlela ephephile nephumelelayo yeziguli ze-R/R T-ALL/T-LBL ezingafaneleki ukwelashwa kwendabuko.

Isiphetho:

Ucwaningo luphetha ngokuthi inhlanganisela yokwelashwa kwe-CD7 CAR-T elandelwa yi-allo-HSCT inikeza indlela yokwelapha ethembisayo nephumelelayo yeziguli ze-R/R T-ALL/T-LBL. Imiphumela yayifana naleyo etholwe nge-chemotherapy kanye ne-allo-HSCT, ngaphandle kokwanda kokufa okungaphindeki, okunikeza inketho yokwelashwa ebalulekile yeziguli ezinezinketho zokwelapha ezilinganiselwe. Okutholakele kocwaningo kunikeza ithemba lokuphulukiswa kwesikhathi eside nokusinda, ikakhulukazi ezigulini ezisengozini enkulu ezihlangana ngesikhathi ne-allo-HSCT.

Umphumela kanye Nombono Wesikhathi Esizayo:

Ukushicilelwa kwalolu cwaningo oluqavile ku Ijenali YaseBrithani Ye-Haematologykuwubufakazi bokuzinikela kanye nobuchwepheshe beThimba Lezokwelapha laseLu Daopei. Le mpumelelo iqokomisa imizamo eqhubekayo yesibhedlela yokuthuthukisa ukwelashwa kwezifo zegazi kanye neminikelo yazo ebalulekile emphakathini wezokwelapha womhlaba wonke. Igcizelela amandla okwelashwa kwe-CD7 CAR-T njengendlela ephumelelayo yeziguli ezine-R/R T-ALL/T-LBL futhi ibonisa ukuzibophezela kwethimba ekucindezeleni imingcele ye-hematological. Ukwelashwa Komdlavuza.