A new weapon to kill tumors: CAR-T cell therapy

Author: Cheng Hongxia Shanxi Bethune Hospital

Reviewer: Zhu Qiujuan, Chief Physician of Hematology Department, Shanxi Bethune Hospital

Hematological malignancies are malignant tumors that originate from the bone marrow, hematopoietic tissue, and lymphoid tissue, including various types of leukemia, lymphoma, and multiple myeloma. The morbidity and mortality of these tumors are among the highest, seriously affecting human health. Traditional treatments for blood tumors include radiotherapy, chemotherapy, and hematopoietic stem cell transplantation. Although these treatments have been widely used and can effectively control the progression of the disease in some cases, they are also accompanied by risks and side effects. With the development of medical technology, CAR-T cell therapy has gradually been used.

1. What is CAR-T cell therapy?

CAR-T (Chimeric Antigen Receptor T Cell) therapy is chimeric antigen receptor T cell immunotherapy, which is a new type of precision targeted therapy for treating tumors.

T lymphocytes are a type of human immune cell. In the laboratory, technicians use genetic engineering technology to activate T cells and install a positioning navigation device CAR (tumor chimeric antigen receptor), transforming ordinary "soldiers" of T cells into "super soldiers", namely CAR-T cells. They use their "positioning navigation device" CAR to specifically identify tumor cells in the body and release a large number of multiple effector factors through immune action. They can efficiently kill tumor cells, thereby achieving the purpose of treating malignant tumors. Therefore, it is also called a new weapon to kill tumors.

2. Which patients are suitable for CAR-T cell therapy?

CAR-T cell therapy is mainly used to treat many types of cancer, especially in hematological malignancies. The following are some of the main diseases that CAR-T cell therapy is currently being studied and used to treat:

1. Blood system

①Leukemia is mainly used to treat relapsed or refractory B-lineage lymphocytic leukemia, including acute lymphocytic leukemia.

②Lymphoma is used to treat a variety of B-cell lymphomas, such as diffuse large B-cell lymphoma, high-grade B-cell lymphoma and Burkitt's lymphoma.

③Multiple myeloma CAR-T cell therapy can control the progression of the disease by accurately killing these malignant plasma cells.

④ For other diseases such as Waldenstrom's macroglobulinemia and mantle cell lymphoma, CAR-T therapy is also gradually exploring its therapeutic effect.

2. Certain solid tumors such as gastric cancer, pancreatic cancer, liver cancer, lung cancer, etc.

3. Other systemic lupus erythematosus, autoimmune hemolytic anemia, immune thrombocytopenia, etc.

3. What is the treatment process of CAR-T cell therapy?

Mainly include:

1. Patient selection: The doctor will evaluate the patient's condition, age, indications, etc. to determine who is eligible for treatment.

2. Collect peripheral blood mononuclear cells and isolate T cells.

3. The collected T lymphocytes are modified in vitro and cultured in vitro to expand the cells.

4. Non-myeloablative preconditioning: By reducing the activity of the immune system, it indirectly increases the survival time and therapeutic effect of therapeutic cells in the patient's body. This method helps adjust the patient's immune system to a state that is more suitable for accepting new cell implants, thereby increasing the possibility of successful treatment. At the same time, this preconditioning method can also reduce the risk of infection and other complications associated with high immune response.

5. Reinfusion: Reinfusion into the patient through intravenous infusion

6. Prevention and treatment of complications and monitoring: Mainly observe whether the patient has cytokine release syndrome (CRS), neurotoxicity, off-target effects, etc. Medical staff observe the patient's condition and treat the symptoms by monitoring the patient's clinical manifestations, vital signs, and various laboratory tests.

Types of social support for CAR-T cell therapy

1. Emotional support makes individuals feel cared for and respected.

2. Information support Information that is useful for the patient's recovery can serve as information support.

3. Economic support Since commercialized CAR-T is an extremely expensive drug with a price of more than one million yuan, it needs economic support from all aspects. The main sources are: ① Huimin Insurance Currently, many cities across the country have Huimin Insurance, and CAR-T cell therapy is included. In terms of compensation amount, the compensation ratio can be as high as 70-80%. ② Commercial insurance Some domestic commercial medical insurance has included CAR-T therapy. Patients who have purchased commercial insurance can consult relevant insurance companies to obtain relevant information. ③ Innovative payment Domestic CAR-T companies have provided patients with a variety of innovative payment methods. ④ Charitable organizations Charitable donations of medicines, social crowdfunding, etc. provide certain financial support for cancer patients and their families to alleviate the financial pressure of patients.

Regarding the treatment and conquest of cancer, Chinese medical scientists have never stopped their research and innovation. From the initial chemotherapy drugs to today's targeted and immunotherapy, we are getting closer and closer to the goal of curing cancer. We look forward to more treatment methods and more diseases being cured in the future, so that patients can truly benefit.