blood cancer treatment Car-T, the cure for blood cancers that gives hope for healing

Car-T, the cure for blood cancers
that gives hope for healing



It is a great promise for the treatment of many blood cancers: an innovative strategy now tested especially on very serious patients, to whom remain a few months of life. Car-T therapy has given very encouraging results against aggressive and indolent lymphomas, different forms of leukemia and myeloma, in adults and children. This sort of "manipulated self-transplantation" is a very sophisticated treatment (and equally risky for the potential serious side effects that it entails) and has been the focus of expert attention gathered at the annual congress of the American Society of Hematology (Ash), held in California a few weeks ago. We asked Umberto Vitolo, director of Hematology at the Cities of Health and Science of Turin, to help us understand more.

Professor, what does Car-T therapy consist of in practice?
"When a tumor develops, it means that our immune system has not been able to react against cancer cells. In particular, T lymphocytes, whose subtypes are responsible for anti-tumor surveillance, are inefficient. The Car-T (T cell lymphocyte, in English Chimeric antigen receptor T cell) technology is very sophisticated and consists in isolating the patient's tumor cells and its T lymphocytes. To do this, a simple leukapheresis is sufficient, ie a procedure collection of lymphocytes and other cells (in practice the method involves extracting, with a simple blood collection lasting a couple of hours, some T lymphocytes of the patient). The difficult thing is to insert a particular receptor (Car) specific for the patient's tumor cells into the patient's T lymphocytes, through a piece of a particular virus, thus making the patient's T cells re-reactive against the tumor cells ".

This is why we talk about "self-manipulated manipulation"?
"Exactly. Once extracted, the T lymphocytes are handled in the laboratory to equip them with two powerful "ammunitions": a receptor to be placed on the external surface (as a sort of "enemy detector") able to recognize the protein present in most of the cells cancerous tumors in question (leukemia, myeloma), much more powerful than the original receptor and able to circumvent some resistance mechanisms adopted by cancer cells; and a mechanism placed inside the T lymphocyte, which stimulates it to expand and proliferate when it attaches itself to the diseased protein, after recognizing it. At this point the enhanced T lymphocytes are expanded in vitro and then reinfused in the patient and begin their action by recognizing the tumor cells and eliminating them. A particularly positive aspect of this strategy is that the action against cancer cells is continuous and lasts substantially forever: that is, if the disease recurs the T-Car identify the new cancerous cells and start to kill them again ".
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Diagnosis of increasing blood cancer

At the Ash meeting in San Diego several studies were presented on this therapy: for which tumors is being tested? And with what results?
"The trial was successfully conducted in lymphoblastic leukemia in recurrence of children and, in fewer cases and with lower results, of adults. There are also ongoing trials in various types of lymphomas and myelomas and we are studying how to do myeloblastic leukemia. In addition, scientific investigations are also being carried out on some solid tumors. Results for now are better in children than adults, as is the case with traditional chemotherapy, because these forms of cancer are more sensitive to therapy in children. Moreover, it has been seen that these modified T-cells (Car-T cells) live longer in children, guaranteeing a longer lasting response. In acute lymphoblastic leukemia, in patients who did not respond to any of the other therapies, high percentages of complete remission were obtained: between 70 and 85 percent, with about 60 percent of patients living at six months and about 50 percent to 18 months, and in some cases with even longer lasting remissions ».


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As always in the scientific field, one can not speak of "miracle cure" ...
"Of course not, because cancer cells can also be resistant to this therapy. And then it is a very complex treatment, which must be conducted in centers with great experience. From the experiments conducted so far, it has emerged that even very serious side effects can occur (neurological, infections and syndrome due to release, stimulated by these T lymphocytes, of particular inflammatory substances that can cause various side effects such as high fever, hypotension, insufficiency respiratory and damage to various organs), which also led to the death of some patients, so the center must also be equipped with resuscitation and emergency intervention units. In short, the conduct of therapy is not easy and only a few centers can be qualified to do so ".

Is this why in Italy it is not available?
"No. The Italian hematology, as the most recent statistics have shown, is at the highest levels all over the world and our avant-garde centers offer the same therapies that can be found in the best foreign facilities. The only difference with T-Car therapy is that at the moment the very sophisticated laboratories capable of successfully manipulating cells are in the US and some are being activated in Europe (Germany and England). In our country, however, experimental studies are starting in the various types of cancer: even if there are no equipped laboratories at the moment, the patient's cells can be sent to the specific laboratory where they are handled and sent back to the center for reinfusion ».