Refrakter B-hujayrali limfomada kashshof CAR-T terapiyasi: Hindiston, Chennai shahri, MIOT International klinikasi misolida klinik holat
Referat
CAR-T hujayra terapiyasi qaytalanadigan yoki refrakter B-hujayrali no-Hodjkin limfoma (R/R B-NHL) uchun istiqbolli davolash usuli sifatida paydo bo‘ldi, ayniqsa terapevtik imkoniyatlari cheklangan bemorlarda. Ushbu maqolada 60 yoshli erkak bemor holati yoritilgan bo‘lib, u birlamchi kimyoterapiyaga refrakter diffuz katta B-hujayrali limfoma (DLBCL) va bir nechta hamroh kasalliklar — qandli diabet, arterial gipertenziya hamda barqaror yurak ishemik kasalligiga ega bo‘lgan. Bemor MIOT International (Chennai, Hindiston) klinikasida anti-CD19 CAR-T hujayra terapiyasi (NEXCAR19) bilan davolangan. R-CHOP kimyoterapiyasining yetti sikli va konsolidatsion nur terapiyasidan so‘ng kasallikning progresiyasi kuzatildi. Shundan so‘ng limfotsit aferez o‘tkazilib, CAR-T hujayralarini ishlab chiqish uchun yetarli boshlang‘ich material olindi. Bemor fludarabin–siklofosfamid asosidagi konditsioner terapiya oldi va 100 mL NEXCAR19 CAR-T hujayralari infuziyasini qabul qildi. Davolash yaxshi o‘tib, sitokin chiqarilish sindromi yoki immun-effektor hujayralarga bog‘liq nevrotoksiklik kuzatilmadi. Davolanishdan 29 kun o‘tib o‘tkazilgan PET-CT tekshiruvida sezilarli metabolik javob (Deauville balli — 4) qayd etildi. Remissiyani mustahkamlash va CAR-T sezuvchanligini oshirish maqsadida past dozali nivolumab bilan qo‘llab-quvvatlovchi terapiya va qoldiq qorin limfa tugunlariga IMRT asosidagi konsolidatsion nur terapiyasi buyurildi. Ushbu klinik holat anti-CD19 CAR-T terapiyasining kimyoterapiyaga refrakter DLBCLda qo‘llanilishi mumkinligini, uning xavfsizligi va erta samaradorligini namoyon etadi, shuningdek, immunoterapiyani nurlanish bilan birlashtirishning afzalliklarini ko‘rsatadi. Uzoq muddatli kuzatuv relaps xavfi va barqaror javobni aniqlaydi.
Mualliflar haqida
Adabiyotlar ro'yxati
Selleslag D. Haploidentical stem cell transplantation in adults: novel strategies and future directions. Belg J Hematol. 2012;3:74-81.
Kumar K, Subash C. A study to identify correlation of hematopoietic progenitor cell (XN-HPC) by Sysmex cell counters with final yield of CD34+ stem cells. Blood. 2017;130(Suppl 1):5458.
Subash C, Kumar K. On demand plerixafor as a rescue strategy in healthy donors to augment peripheral blood stem cell collection in haploidentical transplants. Blood. 2018;132(Suppl 1):5642.
Kumar K, Subash C. Experience of low dose (25 mg/kg) cyclophosphamide (Chennai protocol) as post-transplantation cyclophosphamide (PTCy) in haploidentical transplants. Blood. 2021;138(Suppl 1):4857.
Kumar K, Subash C. Ruxolitinib as GVHD prophylaxis in haploidentical transplantation: clinical outcomes and immune modulation insights from South India. Blood. 2022;140(Suppl 1):6398.
Handgretinger R. Haploidentical transplantation: the search for the best donor. Blood. 2014;124(6):827- 828.
Ghiso A, Raiola AM, Gualandi F, Dominietto A, et al. Donor lymphocyte infusion after haploidentical BMT with post-transplant cyclophosphamide. Bone Marrow Transplant. 2014;50(1):56-61. https://doi. org/10.1038/bmt.2014.217.
Ciurea SO, Champlin RE. Donor selection in T-cell replete haploidentical hematopoietic stem cell transplantation: knowns, unknowns, and controversies. Biol Blood Marrow Transplant. 2013;19(2):180- 184.
Schwarer AP, Bollard G, Kapuscinski M, Muirhead J, et al. Long-term follow-up of a pilot study using a chemotherapy-alone protocol for killer Ig-like receptor-ligand-mismatched haploidentical hematopoietic SCT. Bone Marrow Transplant. 2011;46(10):1331-1338.
Chang YJ, Huang XJ. Haploidentical SCT: the mechanisms underlying the crossing of HLA barriers. Bone Marrow Transplant. 2014;49(7):873-879.
Bayraktar UD, Ciurea SO. Strategies in haploidentical stem cell transplantation in adults. Turk J Haematol. 2013;30(4):342-350.
Solh M. Haploidentical vs cord blood transplantation for adults with acute myelogenous leukemia. World J Stem Cells. 2014;6(4):371-379.
Bashey A, Solomon SR. T-cell replete haploidentical donor transplantation using post-transplant cy- clophosphamide: an emerging standard-of-care option for patients who lack an HLA-identical sibling donor. Bone Marrow Transplant. 2014;49(8):999-1008.
Ciurea SO, Mulanovich V, Saliba RM, Bayraktar UD, Jiang Y, Bassett R, et al. Improved early outcomes using a T-cell replete graft compared with T-cell depleted haploidentical hematopoietic stem cell transplantation. Biol Blood Marrow Transplant. 2012;18(12):1835-1844.
Qanday qilib iqtibos keltirish mumkin
Это произведение доступно по лицензии Creative Commons «Attribution» («Атрибуция») 4.0 Всемирная.