He aha ʻo Tisagenlecleucel: Nā hoʻohana, ka nui o ka lāʻau, nā hopena ʻaoʻao a me nā mea hou aku

He lapaʻau maʻi ʻaʻai ʻo Tisagenlecleucel e hoʻohana ana i kāu mau pūnaewele pale e hakakā i kekahi mau maʻi ʻaʻai koko. ʻO kēia lāʻau lapaʻau hou, i ʻike ʻia hoʻi ʻo CAR-T cell therapy, e lawe i kāu mau T-cells (he ʻano o ke keʻokeʻo koko), hoʻololi iā lākou i loko o kahi keʻena hana e ʻike maikaʻi a hoʻouka i nā pūnaewele maʻi ʻaʻai, a laila hoʻokomo iā lākou i loko o kou kino.

Hōʻike kēia lapaʻau i kahi holomua nui i ka mālama maʻi ʻaʻai pilikino. ʻAʻole like me ka chemotherapy kuʻuna e pili ana i nā pūnaewele e mahele wikiwiki ana, ua manaʻo ʻo tisagenlecleucel i nā pūnaewele maʻi ʻaʻai me ka waiho ʻana i nā pūnaewele olakino i ka nui.

No ke aha e hoʻohana ʻia ai ʻo Tisagenlecleucel?

Hoʻomaʻamaʻa ʻo Tisagenlecleucel i nā ʻano maʻi ʻaʻai koko ke hana ʻole nā ​​lāʻau lapaʻau ʻē aʻe a i ʻole ua hoʻi mai ka maʻi ʻaʻai. Manaʻo maʻamau kāu kauka i kēia lāʻau lapaʻau ke hoʻāʻo ʻoe ma kahi o ʻelua mau ala lapaʻau ʻē aʻe me ka holomua ʻole.

Ua ʻae ʻia ka lāʻau lapaʻau no ka mālama ʻana i ka leukemia lymphoblastic acute (ALL) i nā keiki a me nā ʻōpio a hiki i ka makahiki 25. ʻO ALL kahi maʻi ʻaʻai e ulu wikiwiki ana e pili ana i nā keʻokeʻo koko, e paʻakikī ai i kou kino ke hakakā i nā maʻi a me ka mālama ʻana i ke koko.

Hoʻohana ʻia nō hoʻi no kekahi mau ʻano lymphoma B-cell nui i nā mākua. Aia kēia i ka diffuse large B-cell lymphoma a me nā lymphomas pili ʻē aʻe i hoʻi mai ma hope o ka lapaʻau ʻana a i ʻole ʻaʻole i pane i nā lāʻau lapaʻau mua.

Pehea e hana ai ʻo Tisagenlecleucel?

Hana kēia lapaʻau ma ka hoʻohuli ʻana i kāu ʻōnaehana pale iho i mea ikaika e hakakā i ka maʻi ʻaʻai. Hoʻomaka ke kaʻina hana i ka wā e hōʻiliʻili ai nā kauka i kāu mau T-cells ma o ke kaʻina hana e like me ka hāʻawi ʻana i ke koko.

I loko o ka hale hana, hoʻololi nā ʻepekema i kēia mau pūnaewele ma ka hoʻohui ʻana i kahi mea hoʻokipa kūikawā i kapa ʻia he chimeric antigen receptor (CAR). Hana kēia mea hoʻokipa e like me ka ʻōnaehana GPS, e kōkua ana i kāu mau T-cells e ʻimi a laka i kahi protein kikoʻī i loaʻa ma nā pūnaewele maʻi ʻaʻai i kapa ʻia ʻo CD19.

Ma hope o ka hoʻokomo ʻia ʻana o nā pūnaewele i hoʻololi ʻia i loko o kou kino, e hoʻonui lākou a lilo i mea maikaʻi loa i ka ʻike a me ka luku ʻana i nā pūnaewele maʻi ʻaʻai. E noʻonoʻo e like me ka hāʻawi ʻana i kāu ʻōnaehana pale i ka hoʻomaʻamaʻa kūikawā a me nā mea hana e hakakā i ka maʻi ʻaʻai me ka maikaʻi.

Ua manaʻo ʻia he ala lapaʻau ikaika a paʻakikī. ʻAʻole like me ka chemotherapy maʻamau, hana ʻo tisagenlecleucel i kahi pane pale ola a hoʻomau e hiki ke hoʻomau i ka hana i loko o kou kino no nā mahina a i ʻole nā makahiki.

Pehea wau e lawe ai iā Tisagenlecleucel?

Hāʻawi ʻia ʻo Tisagenlecleucel ma ke ʻano he hoʻokahi infusion intravenous ma kahi kikowaena lapaʻau kūikawā. ʻAʻole hiki iā ʻoe ke lawe i kēia lāʻau ma ka home, a pono ia i ka hoʻomākaukau pono a me ka nānā ʻana e kahi hui lapaʻau i hoʻomaʻamaʻa ʻia.

Ma mua o ka loaʻa ʻana o ka lapaʻau, e hele ʻoe i kahi kaʻina hana i kapa ʻia ʻo leukapheresis e hōʻiliʻili i kāu T-cells. Lawe pinepine kēia i 3-6 mau hola a pili i ka huki ʻana i ke koko mai kekahi lima, hana ʻia ma o kahi mīkini e hoʻokaʻawale i nā T-cells, a laila hoʻihoʻi ʻia i kou lima ʻē aʻe.

ʻOiai e hoʻololi ʻia ana kāu mau pūnaewele i ka hale hana (e lawe ana ma kahi o 3-4 mau pule), hiki iā ʻoe ke loaʻa i ka chemotherapy alahaka e kōkua i ka mālama ʻana i kāu maʻi ʻaʻai. E hāʻawi kāu hui lapaʻau i nā ʻōlelo kikoʻī e pili ana i ka ʻai ʻana, ka inu ʻana, a me nā lāʻau lapaʻau e pale aku i kēia manawa.

He mau lā ma mua o ka infusion, e loaʻa iā ʻoe ka lymphodepleting chemotherapy e hoʻomākaukau i kou kino. Kōkua kēia i ka hana ʻana i kahi ākea no nā pūnaewele i hoʻololi ʻia e ulu a hana pono.

ʻO ka infusion tisagenlecleucel maoli e lawe ma kahi o 30-60 mau minuke. E nānā pono ʻia ʻoe i ka haukapila no ka liʻiliʻi o 10 mau lā ma hope o ka infusion, no ka mea, ʻo ia ka manawa e hiki ai ke loaʻa nā hopena ʻaoʻao koʻikoʻi.

Pehea ka lōʻihi e lawe ai au iā Tisagenlecleucel?

Hāʻawi ʻia ʻo Tisagenlecleucel ma ke ʻano he lapaʻau hoʻokahi, ʻaʻole he lāʻau lapaʻau e lawe pinepine ai ʻoe. Ke hoʻokomo ʻia nā pūnaewele i hoʻololi ʻia i loko o kou kino, ua hoʻolālā ʻia lākou e hoʻomau i ka hana no ka manawa lōʻihi.

Hiki i nā T-cell i hoʻololi ʻia ke noho ikaika i loko o kou kino no nā mahina a i ʻole nā makahiki, e hāʻawi ana i ka pale mau ʻana i nā sela maʻi. Ua mālama kekahi poʻe maʻi i ke kala ʻana no kekahi mau makahiki ma hope o ka loaʻa ʻana o kēia lapaʻau hoʻokahi.

Eia naʻe, e nānā pono kāu hui lapaʻau iā ʻoe me nā koho ukali maʻamau a me nā hoʻokolohua koko. Kōkua kēia mau loiloi i ka hōʻoia ʻana e hana ana ka lapaʻau a nānā i nā hopena ʻaoʻao lohi a i ʻole nā hōʻailona o ka hoʻi ʻana mai o ka maʻi.

He aha nā hopena ʻaoʻao o Tisagenlecleucel?

ʻOiai hiki i ka tisagenlecleucel ke maikaʻi loa, hiki iā ia ke hana i nā hopena ʻaoʻao koʻikoʻi e koi ai i ka lāʻau lapaʻau koke. ʻO ka hoʻomaopopo ʻana i kēia mau mea e kōkua iā ʻoe a me kāu hui lapaʻau e pane wikiwiki inā loaʻa lākou.

ʻO nā hopena ʻaoʻao maʻamau a koʻikoʻi e hana ʻia no ka mea e lilo ana kāu mau sela immune i hoʻololi ʻia i ka hana nui i ka hakakā ʻana i ka maʻi. Hiki i kēia ke hana i kahi pane immune overactive i loko o kou kino.

ʻO ka maʻi hoʻokuʻu cytokine (CRS) ka hopena ʻaoʻao nui loa e nānā ai. Hana ʻia kēia ke hoʻokuʻu ʻia e kāu mau T-cell i hoʻāla ʻia i nā mea inflammatory nui i kapa ʻia ʻo cytokines. ʻO nā hōʻailona mua e komo pū ana:

• Ka wela a me ke anu
• Paʻakikī ka hanu ʻana a i ʻole ka pōkole o ka hanu
• Puʻuwai wikiwiki
• ʻO ka noʻonoʻo a i ʻole ka māmā
• ʻEha poʻo a me nā ʻeha ʻiʻo
• Nausea a me ka luaʻi

Hiki i ka CRS ke hele mai ka maʻalahi a hiki i ke ola, ʻo ia ke kumu e nānā pono ʻia ai ʻoe i ka haukapila. Loaʻa i kāu hui lapaʻau nā lāʻau lapaʻau a me nā lāʻau lapaʻau e mālama pono i kēia maʻi.

Hiki nō hoʻi nā hopena ʻaoʻao neurologic, e pili ana i kou lolo a me ka ʻōnaehana nerve. Hiki i kēia mau mea ke komo pū:

• Huikau a i ʻole ka paʻakikī o ka noʻonoʻo
• Paʻakikī ka ʻōlelo a i ʻole ka loaʻa ʻana o nā huaʻōlelo
• Tremors a i ʻole ka haʻalulu
• Nā hopu (i nā hihia kakaikahi)
• Nā loli i ke kākau lima
• Paʻakikī ka hiamoe

ʻO ka hapa nui o nā hopena ʻaoʻao neurological he mea manawa wale nō a e pau i loko o kekahi mau pule, akā hiki i kekahi ke lōʻihi e pau loa.

ʻO nā hopena ʻē aʻe āu e ʻike ai, penei:

• Ka helu haʻahaʻa o nā cell koko, e hoʻonui ana i ka pilikia o ka maʻi
• Luhi a me ka nāwaliwali
• Hoʻemi ʻia ka ʻai
• Pehu i ka maka, nā lima, a i ʻole nā wāwae
• Ke koko haʻahaʻa
• Ka puʻuwai puʻuwai ʻano ʻē

Hiki i nā hopena lōʻihi ke komo i ka ʻōnaehana pale i nāwaliwali, e hoʻonui ana iā ʻoe i nā maʻi. E kūkākūkā kāu kauka i nā papa hana hoʻopaʻa ʻana a me nā hoʻolālā pale maʻi me ʻoe.

Hiki i nā pilikia kakaʻikahi akā koʻikoʻi ke komo i nā maʻi koʻikoʻi, nā maʻi maʻi lua, a i ʻole ka helu haʻahaʻa o nā cell koko. E nānā pono kāu hui lapaʻau iā ʻoe no kēia mau mea i ka wā o kāu mālama ʻana.

ʻO wai ka mea pono ʻole e lawe iā Tisagenlecleucel?

ʻAʻole kūpono ʻo Tisagenlecleucel no nā mea a pau, a e loiloi pono kāu hui lapaʻau inā he moho maikaʻi ʻoe no kēia lapaʻau. Hiki i kekahi mau mea ke hana i kēia lāʻau lapaʻau kūpono ʻole a i ʻole pilikia loa.

ʻAʻole paha ʻoe e kūpono inā he maʻi ikaika a ʻaʻole i mālama ʻia. Pono kou kino e ma ke kūlana maikaʻi loa e mālama i ka pane immune ikaika a tisagenlecleucel e hana ai.

Hiki i nā pilikia koʻikoʻi o ka puʻuwai, ka māmā, ke ake, a i ʻole nā puʻupaʻa ke hana iā ʻoe i ka pilikia nui no kēia lapaʻau. Hiki i nā hopena ʻaoʻao ke hoʻokau i ke koʻikoʻi hou i kēia mau ʻōpū, no laila pono lākou e hana maikaʻi e mālama i ka lāʻau lapaʻau.

Inā loaʻa iā ʻoe kekahi mau maʻi autoimmune, ʻaʻole kūpono paha kēia lapaʻau. Hiki i ka lāʻau lapaʻau ke hoʻonui i nā maʻi autoimmune ma ka hoʻoikaika hou ʻana i kāu ʻōnaehana pale.

ʻO nā hopena koʻikoʻi i nā lāʻau lapaʻau like ʻole a i ʻole kekahi mau mea o ka lāʻau lapaʻau ke kāpae iā ʻoe mai ka loaʻa ʻana o tisagenlecleucel.

E noʻonoʻo nō hoʻi kāu kauka i kou kūlana olakino holoʻokoʻa, kou makahiki, a me ka maikaʻi o kou hiki ke ʻae i ka nānā ʻana a me nā hopena ʻaoʻao. Pono ka hoʻoholo ʻana i ke kaupaona ʻana i nā pōmaikaʻi kūpono e kūʻē i nā pilikia no kou kūlana kikoʻī.

Inoa inoa o Tisagenlecleucel

Hoʻolaha ʻia ʻo Tisagenlecleucel ma lalo o ka inoa inoa Kymriah. Hoʻohana ʻia kēia inoa inoa ma ka honua holoʻokoʻa, e maʻalahi ai no nā maʻi a me nā mea mālama ola kino e ʻike i kēia lāʻau lapaʻau CAR-T cell.

Hana ʻia ʻo Kymriah e Novartis, he hui lāʻau lapaʻau nāna i hoʻomohala i kēia lāʻau lapaʻau. Ke lohe ʻoe i kekahi inoa - tisagenlecleucel a i ʻole Kymriah - e pili ana lākou i ka lāʻau lapaʻau like.

E hoʻohana paha kāu hui lapaʻau i nā inoa ʻelua me ka hoʻololi ʻana, no laila mai huikau inā lohe ʻoe i nā huaʻōlelo like ʻole e pili ana i kāu lapaʻau.

Nā koho ʻē aʻe o Tisagenlecleucel

Loaʻa nā lāʻau lapaʻau CAR-T cell ʻē aʻe, ʻoiai e kuhikuhi ana kēlā me kēia i nā ʻano maʻi maʻi kikoʻī a me nā heluna maʻi. Hana like kēia mau koho ʻē aʻe me tisagenlecleucel akā loaʻa paha nā hoʻohana ʻae ʻokoʻa a i ʻole nā ​​hopena ʻaoʻao.

ʻO Axicabtagene ciloleucel (Yescarta) kekahi lāʻau lapaʻau CAR-T i ʻae ʻia no kekahi mau lymphomas i nā pākeke. Kuhikuhi pū nō hoʻi ia i ka CD19 akā hana ʻia ma ke ʻano ʻokoʻa a kūpono paha no nā heluna maʻi like ʻole.

Ua ʻae ʻia ʻo Brexucabtagene autoleucel (Tecartus) no kekahi mau ʻano lymphoma a me leukemia. Kuhikuhi kēia lāʻau lapaʻau i ka protein CD19 like akā loaʻa nā hana hana like ʻole.

ʻO Lisocabtagene maraleucel (Breyanzi) kekahi koho no kekahi mau lymphomas, i hoʻolālā ʻia e hana i nā hopena ʻaoʻao liʻiliʻi loa me ka mālama ʻana i ka pono.

Hiki ke noʻonoʻo ʻia nā koho lapaʻau kuʻuna e pili ana i kou kūlana kikoʻī. Aia kēia mau mea i ka chemotherapy maʻamau, ka radiation therapy, a i ʻole ka transplantation cell stem.

Na kāu kauka oncologist e kōkua i ka hoʻoholo ʻana i ke koho maikaʻi loa no kāu ʻano maʻi maʻi kikoʻī, ke olakino holoʻokoʻa, a me ka mōʻaukala lapaʻau.

Ua ʻoi aku ka maikaʻi o Tisagenlecleucel ma mua o nā lāʻau lapaʻau CAR-T ʻē aʻe?

ʻAʻole maʻalahi ka hoʻohālikelike ʻana i nā lāʻau lapaʻau CAR-T no ka mea ua hoʻāʻo ʻia kēlā me kēia mea i nā heluna kanaka like ʻole a me nā ʻano maʻi maʻi. ʻO ka mea nui e ʻimi i ka lāʻau lapaʻau kūpono no kāu kūlana kikoʻī.

Ua hōʻike ʻo Tisagenlecleucel i nā hopena maikaʻi loa i nā keiki a me nā ʻōpio ALL, me ka nui o nā maʻi e loaʻa ana ka remission piha. Ke hōʻike mau nei ka ʻikepili hahai lōʻihi i nā hopena maikaʻi no kēia heluna kanaka.

No nā lymphomas makua, hiki i nā lāʻau lapaʻau CAR-T like ʻole ke kūpono ma muli o ke ʻano kikoʻī o ka lymphoma a me kāu mōʻaukala olakino. Hiki i kekahi mau lāʻau lapaʻau ke loaʻa nā ʻaoʻao ʻokoʻa iki a i ʻole nā manawa hana.

ʻO ke koho

Inā he pilikia iki kou puʻuwai, hiki nō paha iā ʻoe ke kūpono me ka nānā pono ʻana. Akā naʻe, ʻo ka maʻi puʻuwai nui a i ʻole nā puʻuwai i loaʻa i kēia manawa, ʻo ia ka mea e pilikia loa ai kēia lapaʻau.

He aha kaʻu e hana ai inā loaʻa iaʻu ka nui loa o Tisagenlecleucel?

ʻAʻole hiki ke loaʻa ka overdose o Tisagenlecleucel ma ke ʻano maʻamau no ka mea, hāʻawi ʻia ia ma ke ʻano he hoʻokahi, ma ke ana pono ʻia e nā poʻe lapaʻau i aʻo ʻia. Hoʻoholo ʻia ka nui āu e loaʻa ai ma muli o kou kaumaha a me ka helu o nā cell.

Inā hopohopo ʻoe e pili ana i kāu lapaʻau a i ʻole e ʻike ana i nā hōʻailona i manaʻo ʻole ʻia, e hoʻokaʻaʻike koke i kāu hui lapaʻau. Hiki iā lākou ke loiloi inā pili kāu mau hōʻailona i nā hopena maʻamau o ka lapaʻau a i ʻole kekahi mea e pono ai ke komo.

Hahai ka hui lapaʻau i nā protocols paʻa e hōʻoiaʻiʻo e loaʻa iā ʻoe ka dosis kūpono, e hana ana i nā hewa dosing i mea kakaʻikahi loa.

He aha kaʻu e hana ai inā hala iaʻu kahi dosis o Tisagenlecleucel?

Mai ka wā i hāʻawi ʻia ai ʻo tisagenlecleucel ma ke ʻano he infusion hoʻokahi, ʻaʻole hiki iā ʻoe ke

Hiki i nā hopena ke mau no nā mahina a i ʻole nā makahiki, a mālama kekahi poʻe maʻi i ka hoʻōki ʻana no nā manawa lōʻihi ma hope o ka mālama ʻana hoʻokahi. E nānā mau kāu hui lapaʻau iā ʻoe e nānā i ka maikaʻi o ka hana ʻana o ka lāʻau lapaʻau.

Inā hoʻi mai kāu maʻi maʻi a i ʻole ʻaʻole e hana ana ka lāʻau lapaʻau e like me ka mea i manaʻo ʻia, e kūkākūkā kāu kauka i nā koho lapaʻau ʻē aʻe me ʻoe.

Hiki iaʻu ke loaʻa nā lāʻau lapaʻau ma hope o ka lāʻau Tisagenlecleucel?

Pono e mālama pono ʻia kāu papa hana lāʻau lapaʻau ma hope o ka lāʻau tisagenlecleucel. Hiki i ka lāʻau lapaʻau ke hoʻopilikia i ka hiki ʻana o kāu ʻōnaehana pale e pane i nā lāʻau lapaʻau a me ka hakakā ʻana i nā maʻi.

Hoʻomaʻamaʻa ʻia nā lāʻau lapaʻau ola ma hope o ka lāʻau CAR-T no ka mea ua hoʻopilikia ʻia kāu ʻōnaehana pale. E hāʻawi kāu hui lapaʻau i nā alakaʻi kikoʻī e pili ana i nā lāʻau lapaʻau palekana a me ka manawa e loaʻa ai iā lākou.

Manaʻo ka hapa nui o nā kauka e kali ma ka liʻiliʻi he mau mahina ma hope o ka lāʻau lapaʻau ma mua o ka loaʻa ʻana o kekahi mau lāʻau lapaʻau, a pono paha kekahi e nānā mua i kāu hana pale. E kūkākūkā mau me kāu hui lapaʻau ma mua o ka loaʻa ʻana o kekahi lāʻau lapaʻau.