2024-02-01 07:47:50
by Fabrizio Pane
New studies show that patients with relapsed primary mediastinal lymphoma have a 70% chance of responding to therapy
My boyfriend (35 years old) was treated two years ago with Car-T therapy for a primary lymphoma of the mediastinum and is still in remission. What are the chances that you will have a relapse? When can you consider yourself definitively cured?
Answered by Fabrizio Pane, full professor of Hematology and director of the Hematology and Bone Marrow Transplant Unit, Federico II University Hospital, Naples
The chances that your boyfriend will not have a recurrence of the disease two years after Car-T therapy are very high. The term Car-T (chimeric antigen receptor T-cell) is an acronym that indicates a type of immune system cells, T lymphocytes, taken from patients suffering from certain types of neoplastic blood diseases, such as malignant lymphomas, and genetically modified in the laboratory so as to make them capable of attacking the tumor once re-infused into the same patient from which they were taken. The recognition of neoplastic cells by CAR-T lymphocytes is guided by a specific receptor induced on the cell surface of the lymphocyte itself by genetic manipulation, which adapts perfectly to a protein present on neoplastic cells, just as a key adapts to its lock .
When can Car-Ts be used?
Car-T cell therapies represent an innovative, but extremely complex, approach in the treatment of blood cancers and are a therapeutic option for those cases in which previous standard strategies (chemotherapy and haematopoietic stem cell transplantation) have failed. Car-Ts are the first form of immunological cell therapy approved, therefore usable in Italy, for the treatment of refractory or relapsing acute B lymphoblastic leukemia, some forms of aggressive non-Hodgkin lymphoma and advanced follicular type (a short also for multiple myeloma). For reasons that are not yet entirely clear, the effectiveness of this therapy varies in different types of pathologies and, in certain aspects, also in relation to the type of laboratory manipulation of Car-T lymphocytes. Among aggressive lymphomas, the one that appears to be most responsive to Car-T therapy is primary mediastinal lymphoma, an infrequent form (it constitutes 2-3% of non-Hodgkin lymphomas), which predominantly affects young female adults.
The risk of recurrence is low
This disease is very responsive to immuno-chemotherapy, which determines the recovery of 75-80% of patients in the first line. In the past it was much more difficult to treat recurrent disease, but the possibility of using Car-T has changed the prognosis. The data from clinical studies presented at the latest congress of the American Society of Hematology in San Diego, including those presented by Italian specialists, demonstrate that the majority of patients affected by primary mediastinal lymphoma in relapse have a probability of responding to Car- T of approximately 70% and that, once achieved, the response is maintained in the majority of cases. Furthermore, it should be underlined that after 18-24 months the relapses observed in patients treated with Car-T lymphocytes are truly sporadic.
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February 1, 2024 (changed February 1, 2024 | 07:19)
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