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拉丁美洲 CAR-T 治疗的可及性:障碍、缺口与前进路径

英文原题:Access to CAR-T therapy in Latin America: Barriers, gaps, and pathways forward.

PubMed 2026/05/05(内容时间) Semin Immunol Q1 · IF 11.5(JCR 2025)

研究概要

我们得出结论,在拉丁美洲实现公平的CAR-T细胞可及性需要多方面的策略:协调一致的监管框架、可扩展的学术制造、基础设施投资以及整合人群特异性免疫基因组学分析。

中文摘要

嵌合抗原受体(CAR)T细胞疗法已彻底改变了血液系统恶性肿瘤的治疗格局,在弥漫性大细胞淋巴瘤、B细胞白血病和多发性骨髓瘤等疾病中可实现持久缓解。然而,在中低收入国家,尤其是拉丁美洲国家,该疗法的可及性仍然有限。本综述探讨了在拉丁美洲使用CAR-T细胞疗法所面临的挑战,并探索了扩大该治疗可及性的潜在途径。我们讨论了治疗的高昂成本、复杂的生产与物流要求,以及安全给药和管理副作用所需基础设施的不足。社会经济和地理差异进一步限制了可及性。此外,拉丁美洲人群在临床试验中代表性不足,加之该地区的遗传多样性,限制了我们对这类人群中疗效和安全性的理解。新方法包括去中心化的即时医疗生产模式。在试点项目中,这些模式已显示出超过90%的成本降低,同时还有合作项目和创新技术的支持。创新技术的例子包括异体现货型CAR-T产品和基于mRNA的方法。这些方法旨在缩短生产时间、降低成本并提高耐受性。我们得出结论:在拉丁美洲实现公平的CAR-T细胞可及性需要多方面的策略:统一的监管框架、可扩展的学术生产、基础设施投资以及人群特异性免疫基因组分析的整合。科学创新与政策改革和区域合作相结合,可以将CAR-T细胞疗法从一种高成本干预手段转变为适用于多样化患者群体的可持续治疗选择。

展开英文摘要原文

Chimeric antigen receptor (CAR) T cell therapy has transformed the treatment of hematological malignancies, offering durable responses in conditions such as diffuse large cell lymphoma, B-cell leukemias and multiple myeloma. However, access to this therapy is still limited in low- and middle-income nations, especially those in Latin America. This review discusses the challenges to use CAR-T cell therapy in Latin America and explores potential ways to expand access to this treatment. We discuss the high cost of the treatments, the complex manufacturing and logistical requirements, and the insufficient infrastructure for safe administration and managing side effects. Socioeconomic and geographical differences further limit access. Moreover, the under representation of Latin Americans in clinical trials, along with the region's genetic diversity, limits our understanding about the effectiveness and safety in such populations. New approaches include decentralized, point-of-care manufacturing models. These have shown over 90% cost reduction in pilot programs, along with collaborative projects and innovative technology. Examples of innovative technology are allogenic off-the-shelf CAR-T products and mRNA-based approaches. These methods aim to cut production times, lower cost and improve tolerability. We conclude that achieving equitable CAR-T cell access in Latin America requires a multifaceted strategy: harmonized regulatory frameworks, scalable academic manufacturing, investments in infrastructure and integration of population-specific immunogenomic profiling. Scientific innovation combined with policy reform and regional collaboration can transform CAR-T cell therapy from a high-cost intervention into a sustainable treatment option for a diverse patient population.

论文信息

作者
Contreras J、Herschbein L、Mathur N、Guzman ML
第一作者单位
Division of Hematology/ Oncology, Department of Medicine, Meyer Cancer Center Weill Cornell Medicine, United States. Electronic address: joc4006@med.cornell.edu.United States
通讯作者单位
Division of Hematology/ Oncology, Department of Medicine, Meyer Cancer Center Weill Cornell Medicine, United States. Electronic address: mlg2007@med.cornell.edu.United States
文献类型
综述
期刊
Seminars in immunology2026 Jun
原文标识
PubMed 42092292 · DOI 10.1016/j.smim.2026.102029