Chimeric Antigen Receptor (CAR) modified T-cells is one of the next-generation technologies in oncologic medicine. The CAR T-cells rely on the concept of the immune system to treat cancers using genetically modified T-lymphocytes. Several clinical trials have been conducted in the CAR T cell field, with the first FDA-approved CAR T-cell therapy introduced in 2017 in the United States.1 The technology serves as the treatment for patients with relapsed or refractory (R/R) blood cancers such as acute lymphoid leukemia (ALL) and diffuse large B-cell non-Hodgkin lymphoma (DLBCL) who fail the conventional medicines.
1 FDA approval brings first gene therapy to the United States https://www.fda.gov/news-events/press-announcements/fda-approval-brings-first-gene-therapy-united-states Published August 2017.
2 Grigor, E.J., Fergusson, D., Kekre, N., Montroy, J., Atkins, H., Seftel, M.D., Daugaard, M., Presseau, J., Thavorn, K., Hutton, B. and Holt, R.A., 2019. Risks and benefits of chimeric antigen receptor T-cell (CAR-T) therapy in cancer: a systematic review and meta-analysis. Transfusion medicine reviews, 33(2), pp.98-110.
3 Al-Mansour M, Al-Foheidi M, Ibrahim E. Efficacy and safety of second-generation CAR T-cell therapy in diffuse large B-cell lymphoma: A meta-analysis. Mol Clin Oncol. 2020;13(4):33. doi:10.3892/mco.2020.2103
Process for CAR T-cells Therapy
Isolation, Activation, and Transduction
CAR T-cell Infusion
An 11-year-old boy with refractory, multiply relapsed acute lymphoid leukemia.
The boy was diagnosed with B-cell ALL at 3 years of age. He was non-responsive to several rounds of chemotherapy protocols. At 11-year-old, he developed a central nervous system (CNS) relapse with brain tumor. Target therapy-based regimen, intrathecal chemotherapy, brain, and spinal cord irradiation were given, resulting in a new complete remission. Six months later, he again had systemic bone marrow relapse. He was enrolled in compassionate clinical protocol at Ramathibodhi hospital, Bangkok, and was given haploidentical CD19 CAR T-cells donated from his mother. With no serious side effect, the patient remains ongoing complete remission 10+ after the treatment.
Reference: Prasongtanakij, S, Anurathapan, U, Vanichapol, T, et al. Production and characterization of haploidentical CD19 CAR T‐cells: Validated to induce a continuous complete remission in a patient with relapsed refractory B‐cell ALL. Asia-Pac J Clin Oncol. 2020; 18. https://doi.org/10.1111/ajco.13474