If CAR-T has been performed, it has a very significant impact on subsequent efficacy.
If it is murine, anti-murine antibodies may be produced after CAR-T. No matter what murine target is changed, it will no longer be effective because strong immune rejection has been produced in the body.
If it is humanized CAR-T, there is a possibility of repetition.
1. If the previous CAR-T was ineffective, and if it can be determined that there was a problem with the CAR-T product quality, it can be done again.
2. Short-term (within three months) relapse may be a target escape problem. Changing targets may be effective, and strong immune rejection has not yet been produced in the body.
3. Switch to humanized (still containing some murine components) or fully human sources.
Once relapse occurs after CAR-T, the possibility of being effective again is relatively low, except for the above three situations. Even with transplantation + CAR-T, it is still ineffective.
In summary, every choice of CAR-T is particularly important. This situation can be likened to a sniper. Generally, there is only one chance to fire.
For those who have undergone multiple CAR-T treatments, the possibility of success is extremely small unless fully human sources are used.
If the first CAR-T fails, there is no need for subsequent autologous + CAR-T (murine).
Evaluation 30 days after CAR-T: If rapid remission can be achieved, there will generally be a better prognosis. For patients with high tumor burden, non-progression is considered effective.
Three months after CAR-T: At this time, patients in CR generally have a rate of still being in CR after one year of about 87%. Most effective patients should be in CR and PR.
Six-month review: At this time, patients in CR have a rate of still being in CR after 1 year of more than 90%. Some PR patients generally also enter CR status at this time.
One-year review: At this time, meeting the following four points may have the possibility of cure: a. CR, b. Minimal residual disease negative, c. CD19+ B cells are zero or below 0.5%, d. Liquid biopsy is negative.
In a large tumor, in addition to cancer cells, there are many different cell types that together constitute the tumor microenvironment (TME). These include stromal cells, fibroblasts, endothelial cells that constitute blood vessels within the tumor, extracellular matrix, and many different immune cells that researchers are currently most interested in. Tumors influence their microenvironment by secreting growth factors, immunosuppressive molecules, and other signaling molecules that provide a perfect environment for tumor proliferation.
Such a microenvironment is like a spider cave. There are various mechanisms inside that exhaust CAR-T. Using low-dose radiotherapy to attack first can destroy the tumor structure and release presented antigens (MHC), which can efficiently activate CAR-T cells. The maintenance use of PD1 and chidamide after CAR-T is also to improve the tumor microenvironment (TME), release presented antigens (MHC), and activate CAR-T cells
After receiving this treatment, patients need to pay special attention to their lifestyle habits to ensure the maximization of treatment effects and healthy recovery. First, patients should follow medical advice, undergo regular re-examinations and monitoring to evaluate treatment effects and adjust treatment plans in a timely manner. Second, maintaining good dietary habits is crucial. Patients should intake balanced nutrition, including sufficient protein, vitamins, and minerals, to support the normal operation of the immune system. At the same time, moderate exercise also helps improve physical fitness and emotional state. However, in the early stage of treatment, patients may feel fatigued or weak, so they should gradually increase exercise under the guidance of doctors and avoid strenuous exercise.
In addition, special attention should be paid to personal hygiene and infection prevention measures in daily life. Since CAR-T treatment may temporarily lower immunity, patients should avoid crowded places and contact with sick people during the recovery period. Finally, maintaining a positive and optimistic attitude at the psychological level is also very important for recovery. Patients can seek psychological support or join support groups to cope with stress and anxiety that may arise during the treatment process. In short, in the days after CAR-T treatment, patients need to make some adjustments in lifestyle and work closely with the medical team to achieve the best
