决定异体 CAR T 细胞排斥与扩增的细胞和分子机制
Cellular and molecular mechanisms determining allogeneic CAR T cell rejection and expansion.
英文原题:Childhood leukemias in Mexico: towards implementing CAR-T cell therapy programs.
Childhood leukemias in Mexico: towards implementing CAR-T cell therapy programs.
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白血病是全球最常见的儿童癌症类型。过去几十年预后有所改善,许多患者通过化疗等常规治疗得以治愈;然而,许多患者仍表现为难治性疾病,需要额外治疗,包括造血干细胞移植。单克隆抗体免疫治疗或细胞治疗是治疗难治性或复发性血液系统恶性肿瘤的一种有前景的策略。特别是,CAR-T 细胞已在临床试验中显示出临床疗效,目前美国和欧洲的监管机构已批准不同的产品上市。要在全球范围内改善和优化这些疗法的潜力,仍有许多挑战需要解决。细胞治疗的全球可及性是一个重要问题,中低收入国家正在探索不同的策略。在墨西哥,白血病约占儿童患者所有癌症诊断的 50%,且复发/难治性疾病的比例高于其他国家所报告的水平,这是一个多因素问题。尽管过去几十年在白血病诊断和治疗方面取得了重大进展,但让墨西哥患者获得新疗法是一项优先任务,而细胞和基因疗法已初现曙光。目前正在努力使墨西哥患者能够获得 CAR-T 细胞治疗。本文概述了墨西哥儿童白血病的总体情况,并就当前策略、进展以及使白血病的基因和细胞疗法在临床可及方面所面临的挑战提出了我们的观点。
Leukemias are the most common type of pediatric cancer around the world. Prognosis has improved during the last decades, and many patients are cured with conventional treatment as chemotherapy; however, many patients still present with a refractory disease requiring additional treatments, including hematopoietic stem cell transplantation. Immunotherapy with monoclonal antibodies or cellular therapy is a promising strategy for treating refractory or relapsed hematological malignancies. Particularly, CAR-T cells have shown clinical efficacy in clinical trials, and different products are now commercially approved by regulatory agencies in the USA and Europe. Many challenges still need to be solved to improve and optimize the potential of these therapies worldwide.
Global access to cell therapy is a significant concern, and different strategies are being explored in the middle- and low-income countries. In Mexico, leukemias represent around 50% of total cancer diagnosed in pediatric patients, and the rate of relapsed or refractory disease is higher than reported in other countries, a multi-factorial problem.
Although significant progress has been made during the last decades in leukemia diagnosis and treatment, making new therapies available to Mexican patients is a priority, and cell and gene therapies are on the horizon. Efforts are ongoing to make CAR-T cell therapy accessible for patients in Mexico. This article summarizes a general landscape of childhood leukemias in Mexico, and we give a perspective about the current strategies, advances, and challenges ahead to make gene and cell therapies for leukemia clinically available.
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