Turkiye Klinikleri Journal of Internal Medicine

.: REVIEW
Kimerik Antijen Reseptör-T-Hücre Tedavisi
Chimeric Antigen Receptor-T-Cell Therapy
Deniz GÖREN ŞAHİNa, Olga Meltem AKAYb
aHematoloji BD, İstanbul Bilim Üniversitesi Tıp Fakültesi,
bHematoloji BD, Koç Üniversitesi Tıp Fakültesi, İstanbul, TÜRKİYE
Turkiye Klinikleri J Intern Med. 2019;4(3):139-46
doi: 10.5336/intermed.2019-65589
Article Language: TR
Full Text
ÖZET
 Uzun yıllardır kanser tedavisinin esaslarını kemoterapi, radyoterapi ve cerrahi oluşturmakta iken, son iki dekadda 'hedefe yonelik ajanlar' coğu kanserin standart tedavisinde yerini almıştır. Yakın zamanda ise, 'immunoterapi', yani kişinin bağışıklık sisteminin aktive edilerek kanserli hucrelerle mucadele etmesi temeline dayanan yontem, kanser tedavisinde onemli bir alternatif olmuştur. İmmunoterapide elde edilen son gelişme ise kanser tedavisinde devrim olarak gosterilen kimerik antijen reseptor (CAR; chimeric antigen receptor)-T-hucre tedavisidir. Bu tedavi şekli, ozellikle direncli hastalığı olan hematolojik maligniteli vakalara yeni umut ışığı getirmiştir. Klinik denemeler, son donem hastalarda oldukca cesaret verici sonuclar olduğunu gostermiştir. 2017 yılında, iki CAR-T-hucre tedavisi, biri akut lenfoblastik losemili cocukların, diğeri de ilerlemiş lenfomalı erişkinlerin tedavisi icin, Amerikan Gıda ve İlac İdaresi tarafından onaylanmıştır. CAR-T-hucre tedavisi ozellikle B hucre malignitelerine karşı aktif gorulmektedir. Bu durum, CD19 veya CD20'nin tumor hucresi secici ve homojen ekspresyonunun yanı sıra CAR T hucrelerine daha kolay erişimden kaynaklanmaktadır. Ancak, araştırmacılar halen meme kanseri ve kolorektal kanser gibi katı tumorlere karşı etkili olup olmayacağına ilişkin araştırmaları surdurmektedir. CAR-T-hucre tedavisi, etkileyici klinik faydalar gostermiş olsa da bazen yaşamı tehdit edici olabilecek ceşitli toksisiteler ile de ilişkilidir. Sitokin salınım sendromu şu ana kadar en sık gozlenen ilac reaksiyonu olmuştur. Bu calışmada, CAR-T-hucre tedavisinin ozellikleri, yan etkileri ve ozellikle hematolojik kanserlerdeki uygulamalarından bahsedilecektir.

Anahtar Kelimeler: CD19 antijen; hematolojik maligniteler
ABSTRACT
 Chemotherapy, radiation therapy and surgery have been the mainstay of cancer treatment for years, while targeted therapies have cemented as standard treatments for many cancers over the last two decades. Nowadays, immunotherapy based on the activation of the patient's immune system to attack cancer cells-has emerged as an important alternative in cancer treatment. And the latest developments in immunotherapy is a revolutionary cancer treatment called as chimeric antigen reseptor (CAR)-T cell therapy. This type of treatment has brought new hope to patients with relapse/refractary hematological malignancies. Clinical trials have shown very encouraging results in end-stage patients. In 2017, two CAR-T-cell therapies were approved by the Food and Drug Administration, one for the treatment of children with acute lymphoblastic leukemia and the other for adults with advanced lymphomas. CAR-T-cell therapy appears to be especially active against B‐cell malignancies. This is due to the tumor cell selective and homogenous expression of CD19 or CD20 as well as the easier access for CAR-T-cells. Nevertheless, researchers are still investigating whether they will be effective against solid tumors such as breast cancer and colorectal cancer. While CAR-T-cell therapy has shown impressive clinical advantage, it is sometimes related with a variety of toxicities that can be life‐threatening. Cytokine-release syndrome has been the most common observed adverse drug reaction. In this review, the characteristics, side effects and especially the applications of CART- cell therapy in hematological cancers will be discussed.

Keywords: CD19 antigens; hematological neoplasms
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4.9. "Turkiye Klinikleri" may use the information provided to them by the "USERS" through the "SITE" in line with the terms of the "PRIVACY POLICY" and "USER CONTRACT". It may process the information or classify and save them on a database. "Turkiye Klinikleri" may also use the USER's or visitor's identity, address, e-mail address, phone number, IP number, which sections of the "SITE" they visited, domain type, browser type, date and time information to provide statistical evaluation and customized services.

5. PROPRIETARY RIGHTS

5.1. The information accessed through this "SITE" or provided by the users legally and all the elements (including but not limited to design, text, image, html code and other codes) of the "SITE" (all of them will be called as studies tied to "Turkiye Klinikleri"s copyrights) belongs to "Turkiye Klinikleri". Users do not have the right to resell, process, share, distribute, display or give someone permission to access or to use the "Turkiye Klinikleri" services, "Turkiye Klinikleri" information and the products under copyright protection by "Turkiye Klinikleri". Within hereby "Terms of Use" unless explicitly permitted by "Turkiye Klinikleri" nobody can reproduce, process, distribute or produce or prepare any study from those under "Turkiye Klinikleri" copyright protection.

5.2. Within hereby "Terms of Use", "Turkiye Klinikleri" reserves the rights for "Turkiye Klinikleri" services, "Turkiye Klinikleri" information, the products associated with "Turkiye Klinikleri" copyrights, "Turkiye Klinikleri" trademarks, "Turkiye Klinikleri" trade looks or its all rights for other entity and information it has through this website unless it is explicitly authorized by "Turkiye Klinikleri".

6. CHANGES IN THE TERMS OF USE

"Turkiye Klinikleri" in its sole discretion may change the hereby "Terms of Use" anytime announcing within the "SITE". The changed terms of the hereby "Terms of Use" will become valid when they are announced. Hereby "Terms of Use" cannot be changed by unilateral declarations of users.

7. FORCE MAJEURE

"Turkiye Klinikleri" is not responsible for executing late or never of this hereby "Terms of Use", privacy policy and "USER Contract" in any situation legally taken into account as force majeure. Being late or failure of performance or non-defaulting of this and similar cases like this will not be the case from the viewpoint of "Turkiye Klinikleri", and "Turkiye Klinikleri" will not have any damage liability for these situations. "Force majeure" term will be regarded as outside of the concerned party's reasonable control and any situation that "Turkiye Klinikleri" cannot prevent even though it shows due diligence. Also, force majeure situations include but not limited to natural disasters, rebellion, war, strike, communication problems, infrastructure and internet failure, power cut and bad weather conditions.

8. LAW AND AUTHORISATION TO FOLLOW

Turkish Law will be applied in practicing, interpreting the hereby "Terms of Use" and managing the emerging legal relationships within this "Terms of Use" in case of finding element of foreignness, except for the rules of Turkish conflict of laws. Ankara Courts and Enforcement Offices are entitled in any controversy happened or may happen due to hereby contract.

9. CLOSING AND AGREEMENT

Hereby "Terms of Use" come into force when announced in the "SITE" by "Turkiye Klinikleri". The users are regarded to agree to hereby contract terms by using the "SITE". "Turkiye Klinikleri" may change the contract terms and the changes will be come into force by specifying the version number and the date of change on time it is published in the "SITE".

 

30.03.2014

Privacy Policy

We recommend you to read the terms of use below before you visit our website. In case you agree these terms, following our rules will be to your favor. Please read our Terms of Use thoroughly.

www.turkiyeklinikleri.com website belongs to Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. and is designed in order to inform physicians in the field of health

www.turkiyeklinikleri.com cannot reach to user’s identity, address, service providers or other information. The users may send this information to the website through forms if they would like to. However, www.turkiyeklinikleri.com may collect your hardware and software information. The information consists of your IP address, browser type, operating system, domain name, access time, and related websites. www.turkiyeklinikleri.com cannot sell the provided user information (your name, e-mail address, home and work address, phone number) to the third parties, publish it publicly, or keep it in the website. Gathered information has a directing feature to be a source for the website’s visitor profile, reporting and promotion of the services.

www.turkiyeklinikleri.com uses the taken information:

-To enhance, improve and maintain the quality of the website

-To generate visitor’s profile and statistical data

-To determine the tendency of the visitors on using our website

-To send print publications/correspondences

-To send press releases or notifications through e-mail

-To generate a list for an event or competition

By using www.turkiyeklinikleri.com you are considered to agree that;

-Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. cannot be hold responsible for any user’s illegal and immoral behavior,

-Terms of use may change from time to time,

-It is not responsible for other websites’ contents it cannot control or the harms they may cause although it uses the connection they provided.

Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. may block the website to users in the following events:

-Information with wrong, incomplete, deceiving or immoral expressions is recorded to the website,

-Proclamation, advertisement, announcement, libelous expressions are used against natural person or legal identity,

-During various attacks to the website,

-Disruption of the website because of a virus.

Written, visual and audible materials of the website, including the code and the software are under protection by legal legislation.

Without the written consent of Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. the information on the website cannot be downloaded, changed, reproduced, copied, republished, posted or distributed.

All rights of the software and the design of the website belong to Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc.

Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. will be pleased to hear your comments about our terms of use. Please share the subjects you think may enrich our website or if there is any problem regarding our website.

info@turkiyeklinikleri.com