Acute l acute lymphoblastic leukemia and CAR-T Cell immunotherapy: a literature review
Leucemia linfoblástica aguda e imunoterapia com células CAR-T: uma análise da literatura
Resumo
Introduction: The use of CAR-T cells has shown significant results, representing a transformative new treatment option with potentially lasting and even curative responses. This study aims to comprehend CAR-T cell immunotherapy as an innovation for the treatment of B-lineage acute lymphoblastic leukemia (ALL). Methodology: The research was conducted through a bibliographic search in the Medline, PubMed, and Lilacs databases, using the following descriptors: "Acute lymphoblastic leukemia" OR "CAR-T cells" OR "Immunotherapy" and their respective translations into English, between May 2023 and December 2023. Results: The selected studies demonstrated that ALL is a neoplasia with multifactorial etiology, originating in the bone marrow, leading to uncontrolled proliferation of lymphoblasts. However, chemotherapy, despite being the therapeutic method of choice, is considered nonspecific, as the drugs, besides acting on tumor cells, also compromise normal tissues with a high rate of renewal through mitotic division, such as the bone marrow, resulting in adverse reactions. Conclusion: Based on the obtained results, it was possible to conclude that immunotherapy using CAR-T cells has been showing promising results with satisfactory outcomes.
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Referências
AMERICAN CANCER SOCIETY (ACS). Key statistics for acute lymphocytic leukemia (ALL) [Internet]. Atlanta: ACS; 2019. Disponível em: https://www.cancer.org/cancer/acute-lymphocytic-leukemia/about/key-statistics.html. Acesso em 10 jan. 2023.
ANNESLEY, C.E.; SUMMERS, C.; CEPPI, F.; GARDNER, R.A. The Evolution and Future of CAR T Cells for B-Cell Acute Lymphoblastic Leukemia. Clin Pharmacol Ther.103(4):591‐598, 2018
ATIENZA, A.L. Leucemias. Leucemia linfoblástica aguda. Pediatr Integral. XX (6):380-9, 2018.
BRENTJENS, R.J.; DAVILA, M.L.; RIVIERE, I.; PARK, J.; WANG, X.; COWELL, L.G, et al. CD19-targeted T cells rapidly induce molecular remissions in adults with chemotherapy-refractory acute lymphoblastic leukemia. Sci Transl Med. 5(177):177ra38, 2020.
BROWN, P.A.; SHAH, B. Emerging Treatment Options for Acute Lymphoblastic Leukemia: Focus on CAR T-Cell Therapy. J Natl Compr Canc Netw.16(5S):651‐655, 2018.
CRUZ, C.R.; MICKLETHWAITE, K.P.; SAVOLDO, B. et al. Infusion of donor-derived CD19-redirected virus-specific T cells for B-cell malignancies relapsed after allogeneic stem cell transplant: a phase 1 study. Blood. 122(17):2965‐2973, 2013.
DAVILA, M.L.; BOUHASSIRA, D.C.; PARK, J.H. et al. Chimeric antigen receptors for the adoptive T cell therapy of hematologic malignancies. Int J Hematol. 99(4):361‐371, 2014
DAVILA, M.L.; SADELAIN, M. Biology and clinical application of CAR T cells for B cell malignancies. Int J Hematol. Jul;104(1):6-17, 2019.
GONÇALVES, J. Immunotherapy vs CAR-T technology for treatment of Acute Lymphoblastic Leukemia. Repositório Universitário da Ânima. 2022.
HOUOT, R.; SCHULTZ, L.M.; MARABELLE, A.; KOHRT, H. T-cell-based immunotherapy: adoptive cell transfer and checkpoint inhibition. Cancer Immunol Res. Out;3(10):1115-22, 2019.
INSTITUTO NACIONAL DE CÂNCER (INCA). Estimativa 2020: leucemias (taxas brutas) [Internet]. Rio de Janeiro: INCA; 2020. Disponível em: https://www.inca.gov.br/estimativa/taxas-brutas/leucemias. Acesso em 10 jan. 2023.
JUNE, C.H.; LONIAL, S.; MALONEY, D.G.; TOUCHON, P. Weighing the cost and value of CAR T-cell therapy. Disponível em: https://www.ascopost.com/issues/may-25-2018/weighing-the-cost-and-value-ofcar-t-cell-therapy/. Acesso em 15 jan. 2023.
KALOS, M.; LEVINE, B.L.; PORTER, D.L.; KATZ, S. et al. T cells with chimeric antigen receptors have potent antitumor effects and can establish memory in patients with advanced leukemia. Sci Transl Med. 2021 Ago;3(95):95ra73.
LAMEGO, R.M; CLEMENTINO, N.C.D.; COSTA, A.L.B.; OLIVEIRA, M.J.M.; BITTENCOURT, H. Transplante alogênico de células-tronco hematopoéticas em leucemias agudas: a experiência de dez anos do Hospital das Clínicas da UFMG. Rev Bras Hematol Hemoter. 32(2):108-15, 2010.
LIU, J.; ZHANG, X.; ZHONG, J.F.; ZHANG, C. CAR-T cells and allogeneic hematopoietic stem cell transplantation for relapsed/refractory B-cell acute lymphoblastic leukemia. Immunotherapy. 9(13):1115‐1125, 2017.
MALLARD, F.; MOHTY, M. Acute lymphoblastic leukaemia. Lancet. 395(10230):1146-62. https://doi.org/10.1016/S0140-6736(19)33018-1, 2020.
MAUDE, S.L.; TEACHEY, D.T.; PORTER, D.L. CD19-targeted chimeric antigen receptor T-cell therapy for acute lymphoblastic leukemia. Blood. 125(26):4017-4023, 2021.
OSTROWSKI, R.B.; SILVA, A.R.: GAMA, E.C. Imunoterapy in acute lymphoblastic leukemia treatment. Brazilian Journal of Health Review. Curitiba, v.5, n.1, p. 122 - 125 2022.
PAUL, S.; KANTARJIAN, H.; JABBOUR, E.J. Adult acute lymphoblastic leukemia. Mayo Clin. 91(11):1645-66. https://doi.org/10.1016/j.mayocp.2016.09.010, 2019.
QASIM, W.; ZHAN, H.; SAMARASINGHE, S. et al. Molecular remission of infant B-ALL after infusion of universal TALEN gene-edited CAR T cells [published correction appears in Sci Transl Med. 2017 Feb 15;9(377). Sci Transl Med. 9(374), 2017
QIN H, C.H.O.M.; HASO, W.; et al. Eradication of B-ALL using chimeric antigen receptor-expressing T cells targeting the TSLPR oncoprotein. Blood. 2015;126(5):629‐639.
SÁNCHEZ, M.A.O.; ORTEGA, M.L.O.; BARRIENTOS, J.V.R. Leucemia linfoblástica aguda. Med Int Mex. 23(1):26-33, 2007.
WEI. G.; DING, L.; WANG, J.; HU, Y.; HUANG, H. Advances of CD19-directed chimeric antigen receptor-modified T cells in refractory/relapsed acute lymphoblastic leukemia. Exp Hematol Oncol. Abr;6(1):10, 2019.
WYATT, K.D.; BRAM, R.J. Immunotherapy in pediatric B-cell acute lymphoblastic leukemia. Hum Immunol. 80(6):400-8. https://doi.org/10.1016/j. humimm.2019.01.011, 2019.
ZHAO, Z.; CHEN, Y.; ZHANG, Y.; WU, M. The application of CAR-T cell therapy in hematological malignancies: advantages and challenges. Acta Pharm Sin B. 8(4):539-51, 2018.