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Asensi Cantó P, Arnao Herraiz M, de la Rubia Comos J. Immunotherapy in multiple myeloma. Med Clin (Barc) 2024:S0025-7753(23)00753-4. [PMID: 38218655 DOI: 10.1016/j.medcli.2023.11.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 11/14/2023] [Accepted: 11/15/2023] [Indexed: 01/15/2024]
Abstract
Patients with multiple myeloma who present with refractory disease or relapse after receiving the main classes of available drugs -immunomodulators, proteasome inhibitors and antibodies against CD38- do not have satisfactory therapeutic alternatives. New treatments based on the redirection of T lymphocytes to act directly against tumor cells, such as bispecific antibodies and T cells with chimeric antigen receptors, are changing this scenario. The published information confirms unprecedented antitumor activity of these agents in patients with refractory myeloma and they will certainly represent the backbone of the treatment of these patients in the immediate future. However, these therapies also present specific characteristics and medium or long-term toxicities that pose new healthcare challenges. In this review, we address the current results and future challenges of the administration of these treatments in patients with relapsed or refractory multiple myeloma.
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Affiliation(s)
- Pedro Asensi Cantó
- Servicio de Hematología y Hemoterapia, Hospital Universitario y Politécnico La Fe, Valencia, España
| | - Mario Arnao Herraiz
- Servicio de Hematología y Hemoterapia, Hospital Universitario y Politécnico La Fe, Valencia, España
| | - Javier de la Rubia Comos
- Servicio de Hematología y Hemoterapia, Hospital Universitario y Politécnico La Fe, Valencia, España; Facultad de Medicina y Odontología, Universidad Católica de Valencia, Valencia, España; Instituto de Investigación Sanitaria La Fe, Valencia, España; Ciberonc CB16/12/00284, Valencia, España.
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Mirones I, Moreno L, Patiño-García A, Lizeaga G, Moraleda JM, Toribio ML, Pérez-Martínez A. [Immunotherapy with CAR-T cells in paediatric haematology-oncology]. An Pediatr (Barc) 2020; 93:59.e1-59.e10. [PMID: 32107177 DOI: 10.1016/j.anpedi.2019.12.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 12/26/2019] [Accepted: 12/27/2019] [Indexed: 10/24/2022] Open
Abstract
Despite being a rare disease, cancer is the first cause of mortality due to disease during the paediatric age in the developed countries. The current, great increase in new treatments, such as immunotherapy, constitutes a new clinical and regulatory paradigm. Cellular immunotherapy is one of these types of immunotherapy. In particular, the advanced therapy drugs with chimeric antigen receptors in the T-lymphocytes (CAR-T), and particularly the CAR-T19 cells, has opened up a new scenario in the approach to haematology tumours like acute lymphoblastic leukaemia and the B-Cell lymphomas. The approval of tisagenlecleucel and axicabtagene ciloleucel by the regulatory authorities has led to the setting up of the National Plan for Advanced Therapies-CAR-T drugs in Spain. There is evidence of, not only the advantage of identifying the centres most suitable for their administration, but also the need for these to undergo a profound change in order that their healthcare activity is extended, in some cases, to the ability for the in-house manufacture of these types of therapies. The hospitals specialised in paediatric haematology-oncology thus have the challenge of progressing towards a healthcare model that integrates cellular immunotherapy, having the appropriate capacity to manage all aspects relative to their use, manufacture, and administration of these new treatments.
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Affiliation(s)
- Isabel Mirones
- Unidad de Investigación Traslacional y Terapias Avanzadas, Servicio de Hemato-Oncología Pediátrica, Hospital Universitario La Paz, Madrid, España
| | - Lucas Moreno
- Servicio de Hemato-Oncolología Pediátrica, Hospital Universitario Vall d'Hebron, Barcelona, España
| | - Ana Patiño-García
- Instituto de Investigación Sanitaria de Navarra (IDISNA), Pamplona, España. Programa de Tumores Sólidos y Biomarcadores, Fundación para la Investigación Médica Aplicada, Pamplona, España. Departamento de Pediatría, Clínica Universidad de Navarra, Pamplona, España
| | - Garbiñe Lizeaga
- Servicio de Farmacia, Hospital Universitario Donostia, San Sebastián, Guipúzcoa, España
| | - José M Moraleda
- Sección de Hemato-Oncolología Pediátrica, Unidad de TPH y Terapia Celular, Servicio de Hematología, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, España. Instituto Murciano de Investigación Biosanitaria (IMIB), Universidad de Murcia, Murcia, España
| | - María Luisa Toribio
- Programa Interacciones con el Ambiente, Unidad Desarrollo y Función del Sistema Inmunitario, Centro de Biología Molecular Severo Ochoa, CSIC-UAM, Madrid, España
| | - Antonio Pérez-Martínez
- Unidad de Investigación Traslacional en Hemato-Oncología Pediátrica, Trasplante de Progenitores Hematopoyéticos y Terapia Celular, Hospital Universitario La Paz, Madrid, España. Servicio de Hemato-Oncología Pediátrica, Hospital Universitario La Paz, Madrid, España.
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Corral Sánchez MD, Fernández Casanova L, Pérez-Martínez A. Beyond CAR-T cells: Natural killer cells immunotherapy. Med Clin (Barc) 2019; 154:134-141. [PMID: 31771858 DOI: 10.1016/j.medcli.2019.08.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Revised: 07/30/2019] [Accepted: 08/27/2019] [Indexed: 10/25/2022]
Abstract
Children and adolescents suffering from refractory leukaemia, relapse after stem cell transplantation, solid metastatic tumour or refractory to conventional treatments still condition a dismal prognosis. The critical role of the immune system in the immunosurveillance of cancer is becoming relevant with the development of new treatments such as the checkpoint inhibitor drugs and genetic modified T lymphocytes, tisagenlecleucel or axicabtagene ciloleucel. In addition, other immunotherapies are being developed such as cell therapy with natural killer (NK) lymphocytes. The rapid and potent cytotoxic activity of NK cells respecting healthy cells and the possibility of expansion, manipulating them and combining them with other treatments, make these cells a powerful therapeutic tool to be developed, with a very high safety profile. Furthermore, new strategies are being developed to increase the therapeutic benefit of NK cells such as genetic manipulation for the expression of chimeric antigen receptors.
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Affiliation(s)
| | | | - Antonio Pérez-Martínez
- Servicio de Hemato-Oncología Pediátrica, Hospital Universitario La Paz, Madrid, España; Departamento de Pediatría, Facultad de Medicina, Universidad Autónoma de Madrid (UAM), Instituto de Investigación Sanitaria del Hospital Universitario La Paz (IdiPAZ), Madrid, España.
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