Koj puas tau xav tias peb lub cev muaj peev xwm tawm tsam mob qog noj ntshav ntawm nws tus kheej? Qhov tseeb, peb lub cev muaj ib lub cev tiv thaiv kab mob ntse heev hu ua lub cev tiv thaiv kab mob. Nws muaj ib feem tshwj xeeb hu ua T-cells, uas zoo li cov tub rog. Lawv txoj haujlwm yog nrhiav thiab rhuav tshem cov kab mob txawv teb chaws thiab cov cell hloov pauv uas nkag mus rau hauv lub cev. Tab sis qee zaum, cov cell qog noj ntshav ntse heev. Lawv nkaum ntawm cov cell T no, dag lawv thiab loj hlob hauv lub cev. Thaum lub sijhawm zoo li no, peb yuav tham txog kev kho mob tshiab, zoo kawg nkaus uas pab peb cov cell T paub thiab rhuav tshem cov cell qog noj ntshav los ntawm kev muab "kev cob qhia tshwj xeeb" rau lawv.
Hais yooj yim xwb, kev kho mob CAR T-cell yog dab tsi?
Txawm hais tias lub npe yuav zoo li nyuaj, lub tswv yim yooj yim heev. Kev kho mob CAR T-cell yog ib hom kev kho mob tiv thaiv kab mob. Nws cuam tshuam nrog kev coj qee cov T cell thiab hloov kho lawv hauv chav kuaj mob.
Xav txog koj cov T cell ua cov tub ceev xwm. Cov cell mob qog noj ntshav zoo li cov tub sab nyiag uas zais lawv tus kheej. Feem ntau, cov tub ceev xwm tsis tuaj yeem paub cov tub sab nyiag no. Kev kho mob CAR T-cell zoo li muab ib khub tsom iav tshwj xeeb rau koj cov tub ceev xwm (T cell). Daim iav no hu ua 'Chimeric Antigen Receptor' (CAR) . Nws yog tsim nyob rau hauv chav kuaj thiab txuas rau cov T cell.
Tam sim no, thaum daim iav tshwj xeeb no raug muab tso rau, cov T cell tuaj yeem paub meej txog cov protein tshwj xeeb (antigens) ntawm qhov chaw ntawm cov cell mob qog noj ntshav. Cov cell mob qog noj ntshav uas tau zais cia yav dhau los tam sim no pom tseeb. Cov T cell, uas tau txais cov hwj chim loj no, ces mus ncaj qha mus tawm tsam cov cell mob qog noj ntshav thiab rhuav tshem lawv. Kev kho mob no yog ib qho kev pab zoo hauv kev kho qee hom mob qog noj ntshav thiab pab lwm tus kom nyob ntev dua nrog mob qog noj ntshav.
Kev kho mob no kho tau hom mob qog ntshav twg?
Tam sim no, kev kho mob CAR T-cell tsuas yog siv rau qee hom mob qog ntshav uas tsis teb rau lwm yam kev kho mob (xws li chemotherapy) lossis uas rov qab los tom qab kev kho mob. Vim tias nws tseem yog ib qho kev kho mob tshiab heev, nws tsis tau muab rau txhua yam mob qog ntshav.
Lub rooj hauv qab no qhia txog hom mob qog noj ntshav twg uas kev kho mob no tau pom zoo rau tam sim no.
| Hom Mob Cancer | Kev piav qhia |
|---|---|
| Kab mob B-cell acute lymphoblastic leukemia (ALL) | B-cell mob qog ntshav lymphoblastic mob hnyav |
| Diffuse loj B-cell lymphoma | Diffuse loj B-cell lymphoma |
| Cov kab mob follicular lymphoma | Cov kab mob follicular lymphoma |
| Kab mob B-cell lymphoma theem siab | Kab mob B-cell lymphoma theem siab |
| Mantle cell lymphoma | Mantle cell lymphoma |
| ntau yam mob myeloma | ntau yam mob myeloma |
| Thawj qhov mediastinal loj B-cell lymphoma | Thawj qhov mediastinal loj B-cell lymphoma |
Cov txheej txheem kho mob no tshwm sim li cas?
Tag nrho cov txheej txheem no ua tiav hauv ntau kauj ruam. Zoo li cob qhia cov tub rog rau kev ua tsov rog thiab tom qab ntawd xa lawv rov qab mus rau thaj chaw sib ntaus sib tua.
Kauj Ruam 1: Sau koj cov T cell
Ua ntej, koj lub cev yuav tsum tau sau cov qe ntshav dawb, tshwj xeeb yog cov qe ntshav T. Qhov no ua tiav los ntawm ib txoj kev hu ua leukapheresis . Qhov no suav nrog kev xa koj cov ntshav los ntawm lub tshuab, uas cais cov qe ntshav dawb xwb, thiab xa cov ntshav seem rov qab rau koj lub cev. Qhov no zoo li kev pub ntshav, tab sis tsuas yog ib feem ntawm cov ntshav thiaj li raug coj mus thiab cov seem rov qab los.
2. Kauj Ruam: Xa cov T cell mus rau chav kuaj thiab hloov kho lawv
Tom ntej no, cov T cell uas koj tau txais yuav raug xa mus rau ib lub chaw kuaj mob tshwj xeeb. Nyob ntawd, cov kws tshawb fawb siv kev tsim kho caj ces los ntxig CAR (Chimeric Antigen Receptor) uas peb tau tham txog ua ntej rau hauv cov T cell. Tom qab ntawd, cov CAR T cell tshiab uas muaj zog heev no raug loj hlob hauv chav kuaj mob kom txog thaum lawv muaj ntau lab tus. Cov txheej txheem no siv sijhawm peb txog rau lub lis piam.Tej zaum yuav siv sijhawm me ntsis.
3. Kauj Ruam: Npaj koj lub cev
Txog thaum cov CAR T-cells tsim tau hauv chav kuaj mob, koj tus kws kho mob yuav muab lwm yam kev kho mob rau koj (kev kho txuas ntxiv), xws li kev siv tshuaj kho mob qog noj ntshav, los tswj koj tus mob qog noj ntshav.
Tom qab ntawd, ob peb hnub ua ntej cov CAR T-cell tshiab tsim tau muab rau koj, koj yuav tau txais kev kho mob chemotherapy tsawg. Nws hu ua lymphodepleting chemotherapy . Qhov no ua haujlwm los ntawm kev ua kom koj lub cev cov hlwb tiv thaiv kab mob uas twb muaj lawm ploj mus, tsim kom muaj ib puag ncig zoo dua rau cov tshiab, super CAR T-cell ua haujlwm.
4. Kauj Ruam: Rov qab muab cov super T cell rov qab rau hauv lub cev
Qhov no yog qhov kev tshwm sim tseem ceeb. Ib yam li kev muab cov kua saline, cov CAR T-cell tshiab uas tsim tau raug txhaj rau hauv koj lub cev los ntawm cov leeg ntshav (kab intravenous - IV). Qhov no siv sijhawm ntawm 5 thiab 30 feeb. Thaum cov cell no nkag mus rau hauv lub cev, lawv pib loj hlob ntawm lawv tus kheej, nrhiav thiab rhuav tshem cov cell mob qog noj ntshav. Vim tias cov cell no nyob hauv lub cev ntev thiab tawm tsam mob qog noj ntshav, qee tus hu qhov kev kho mob no ua "tshuaj muaj sia."
Tom qab kho mob tas, yuav muaj dab tsi tshwm sim? Tej yam txaus ntshai yog dab tsi?
Vim tias qhov no yog kev kho mob muaj zog heev, qee zaum yuav muaj cov kev mob tshwm sim loj heev. Yog li ntawd, koj yuav tsum nyob hauv tsev kho mob li ib lub lim tiam txog kaum hnub tom qab kev kho mob. Cov kws kho mob thiab cov kws tu mob yuav saib xyuas koj ze.
Qhov tseem ceeb tshaj plaws yog koj yuav tsum nyob ze tsev kho mob uas koj tau txais kev kho mob rau thawj lub hlis tom qab tawm hauv tsev kho mob. Tsis tas li ntawd, koj yuav tsum muaj ib tus neeg nrog koj 24 teev hauv ib hnub . Tsis tas li ntawd, nws tsis yog lub tswv yim zoo rau kev tsav tsheb rau ob lub hlis .
Cov Kev Mob Tshwm Sim Tseem Ceeb
Muaj ob qho kev mob tshwm sim tseem ceeb thiab feem ntau tshwm sim los ntawm kev kho mob no. Txawm hais tias cov no tuaj yeem ua rau muaj kev phom sij, cov pab pawg kho mob tau npaj txhij los kho lawv.
| Hom kev phiv tshuaj | Cov tsos mob uas yuav tshwm sim |
|---|---|
| Cytokine Release Syndrome Ib qho kev tiv thaiv kab mob muaj zog uas tshwm sim hauv lub cev thaum CAR T-cells rhuav tshem cov hlwb qog noj ntshav. |
|
| Cov Teeb Meem Txog Lub Hlwb Cov teebmeem rau lub hlwb thiab lub paj hlwb. | |
| Lwm yam kev mob tshwm sim uas yuav tshwm sim | |
| |
Kev kho mob no ua tau zoo npaum li cas?
Kev kho mob CAR T-cell tau coj kev cia siab tshiab rau ntau tus neeg uas tawm tsam mob qog ntshav, tshwj xeeb tshaj yog cov neeg uas tsis tau teb rau lwm yam kev kho mob.
- Piv txwv li, ntau tshaj 85% ntawm cov menyuam yaus uas tau txais kev kho mob no rau cov menyuam yaus uas muaj mob qog ntshav lymphoblastic (ALL) tau zoo tag nrho tom qab kev kho mob. Thiab, 60% ntawm lawv tseem tsis muaj mob qog ntshav ib xyoos tom qab kev kho mob.
Txawm li cas los xij, peb yuav tsum nkag siab tias qhov no tsis yog ib qho kev kho mob khawv koob - txhua yam uas yuav ua haujlwm 100% rau txhua tus. Rau qee tus neeg, kev kho mob no yuav kho lawv tus mob qog noj ntshav tag nrho. Rau lwm tus, nws yuav pab lawv tswj lawv tus mob qog noj ntshav thiab nyob ntev dua. Tsis tas li ntawd, rau qee tus neeg, kev kho mob no yuav tsis ua tiav.
Cov thev naus laus zis no tseem tab tom hloov zuj zus. Cov kws tshawb fawb thoob plaws ntiaj teb tab tom sim txhim kho txoj kev kho mob no, txo cov kev mob tshwm sim, thiab saib seb nws puas siv tau rau lwm hom mob qog noj ntshav.
Thaum twg koj yuav tsum mus ntsib kws kho mob?
Cov kev mob tshwm sim ntawm kev kho mob no, tshwj xeeb tshaj yog Cytokine Release Syndrome thiab teeb meem ntawm lub paj hlwb, tuaj yeem ua rau tuag taus . Yog li ua ntej koj tawm hauv tsev kho mob, nug koj tus kws kho mob seb koj yuav tsum paub txog cov tsos mob dab tsi.
Yog tias cov tsos mob xws li kub taub hau, mob khaub thuas, mob taub hau, thiab xeev siab tseem muaj, nws yuav yog ib qho cim qhia tias muaj mob hnyav. Yog tias muaj, hu rau koj tus kws kho mob tam sim ntawd lossis mus rau chav kho mob ceev (ETU) ntawm tsev kho mob.
Yog koj lossis ib tug neeg koj paub muaj mob qog ntshav, nrog koj tus kws kho mob tham txog seb kev kho mob CAR T-cell puas yog rau koj. Txawm hais tias kev kho mob no tsis yog rau txhua tus, nws tuaj yeem yog qhov kev paub hloov pauv lub neej rau tus neeg tsim nyog.
Cov Lus Qhia Txog Kev Coj Mus Tsev
- Kev kho mob CAR T-cell yog "tshuaj kho mob uas muaj sia nyob" uas hloov koj cov hlwb T uas tiv thaiv kab mob mus ua cov hlwb loj uas tua cov hlwb mob qog noj ntshav.
- Qhov no tsuas yog siv rau qee hom mob qog ntshav uas lwm yam kev kho mob tsis ua tiav.
- Cov txheej txheem suav nrog kev sau koj cov cell, hloov kho lawv hauv chav kuaj, thiab xa rov qab rau koj lub cev.
- Vim tias tej zaum yuav muaj cov kev mob tshwm sim loj tom qab kev kho mob, nws yog ib qho tseem ceeb uas yuav tsum tau nyob hauv kev saib xyuas mob tas li hauv tsev kho mob.
- Txawm hais tias kev kho mob no coj kev cia siab tshiab rau ntau tus neeg, nws yog ib qho tseem ceeb kom nkag siab tias nws tsis muab kev kho mob rau txhua tus.
- Tsuas yog koj tus kws kho mob qog nqaij hlav thiaj li txiav txim siab seb qhov kev kho mob no puas yog rau koj, yog li ua siab dawb siab zoo nrog nws txog txhua yam.
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Tsis muaj lus teb tau muab tso tawm. Ntxiv koj cov lus tawm ntawm no thawj zaug.
Ntxiv koj cov lus