Why do some patients do well with CAR-T therapy and others do not? Is there a way to predict CAR-T efficacy before treatment?
.
The effect of CAR-T therapy can vary significantly and heterogeneously from patient to patient. Some may have a complete or partial response, others may not respond at all, or relapse after a response has been achieved. These differences in response may be related to the different nature of the patient’s tumor cells and the patient’s autoimmune cells.
There are no clear predictors of efficacy and are still under investigation. Patients with lymphoma may have a good prognosis if their C-reactive protein or ferritin values are low before treatment.
Can CAR-T be used in combination with other therapies?
Yes.
Yes.
CAR-T cells are highly effective in treating acute lymphoblastic leukemia, but are prone to relapse, and to reduce relapse, hematopoietic stem cell transplantation can be performed after remission with CAR-T cells to improve prognosis and long-term survival. The combination of BTK inhibitors or checkpoint inhibitors to promote the expansion or survival of CAR-T cells in vivo may improve the efficacy of CAR-T cells in treating lymphoma or chronic lymphocytic leukemia. In addition, residual isolated lesions after CAR-T cell therapy may be treated with a combination of local radiotherapy.
What is dual-targeted CAR-T therapy?
What is dual-targeted CAR-T therapy?
A dual-target CAR-T is a CAR-T cell that recognizes 2 different tumor antigens on the surface of tumor cells. Theoretically, dual-targeted CAR-T cells can improve the overall efficacy of CAR-T cell therapy by increasing the tumor-killing effect and reducing relapse due to tumor antigen escape.
Most clinical studies are currently using dual-target CAR-T against CD19 and CD22, and dual-target CAR-T against CD19 and CD20.
Will unsuccessful CAR-T treatment affect other subsequent treatments?
No.
No, it will not affect other subsequent therapies.
It is possible to continue with other second- or third-line regimens such as chemotherapy or transplantation after a failed CAR-T treatment. A variety of new drugs, including targeted drugs, are now available for lymphoma/myeloma, and some patients with refractory relapses can have good outcomes and can be tried as a priority.
Can CAR-T completely cure leukemia?
CAR-T cell therapy may cure some patients with leukemia.
Recent clinical data suggest that among patients with acute lymphoblastic leukemia, one third of those with less than 5% myeloid leukemia cells prior to CAR-T treatment but with detectable minimal residuals may achieve long-term disease-free survival; on the other hand, CAR-T cells may be 71% effective in treating chronic lymphocytic leukemia, with profound remission of sequencing IgH rearrangement negative. On the other hand, CAR-T cell therapy for chronic lymphocytic leukemia is also 71% effective, and this group of patients who achieve deep remission with sequencing IgH rearrangement negativity are likely to achieve long-term disease-free survival, which is commonly referred to as “cure.
Can CAR-T completely cure lymphoma?
Can CAR-T cure lymphoma?
CAR-T cell therapy may cure some patients with refractory relapsed B-cell lymphoma. If they remain in complete remission (lymphoma disappearance or absence of metabolic activity confirmed by PET-CT) for 6 months after CAR-T treatment, most of these patients will achieve long-term disease-free survival, which is commonly referred to as a “cure.