摘要
近年来,以造血干细胞移植、生物治疗、靶向药物等为代表的一批临床新技术的应用,让白血病的诊治水平得到了很大的提高,让患者看到了新的希望,但仍有部分白血病患者不能治愈,其中复发/难治性急性B淋巴细胞白血病仍是临床面临的一大挑战,严重制约白血病疗效,是儿童白血病患者死亡的主要原因之一。而嵌合抗原受体修饰的T细胞(CAR-T)是一种安全有效的肿瘤治疗方法。在多种血液肿瘤的临床试验中,CAR-T细胞疗法取得重大突破,尤其在复发难治的急性B淋巴细胞白血病取得显著的疗效。(1)本文列举一典型病例关于儿童急性B淋巴细胞白血病经过标准的一系列化疗方案后缓解再复发并伴中枢神经系统白血病的复发,通过二代CD19 CAR-T细胞治疗后,观察其细胞回输后患者的临床疗效,并配合中药十全大补汤加减口服,通过益气扶正的方法增加患者的正邪抗争的能力,使患者能达到持续缓解的状态。(2)本文还结合嵌合抗原受体(CAR)的结构、二代CAR细胞的优势、CAR-T细胞抗肿瘤的作用机制结合本病案进行具体分析。(3)本文还证明了CAR-T细胞治疗复发/难治CD19抗原阳性急性淋巴细胞白血病的是可行的方法,能够清除耐药患者体内恶性肿瘤细胞,甚至达到完全缓解,但最终会走向复发,怎样使患者持续达到缓解状态,仍是一个待解决的问题。现报告如下。
In recent years,hematopoietic stem cell transplantation,biological treatment,targeted drugs,etc.represent a number of clinical application of new technology for leukemia treatment,the diagnosis and treatment level has been greatly improved,which give patients a new hope,but there are still some leukemia patients cannot be cured,among which relapse/refractory acute B lymphocytic leukemia is a clinical big challenge,which restricts leukemia curative effect and is one of the leading causes of death among patients with leukemia in children.The modification of chimeric antigen receptors of T cells(CAR)is a kind of safe and effective method of tumor treatment.In a variety of blood tumor clinical trials,major breakthroughs are made in the CAR-T cell therapy,it achieves remarkable curative effect in the treatment of recurrence of the refractory acute B lymphocytic leukemia.①This article lists the typical cases of children with acute B lymphocytic leukemia relief after a standard series of chemotherapy regimens,who suffers from recurrence and relapse of leukemia associated with central nervous system,through the second generation CD19 CAR-T cells treatment,the patient's clinical curative effect is observed and oral administration of Shiquan Dabu Decoction(十全大补汤)is cooperated,the patients can achieve the state of continuous relief through improving theirs ability to fight against the disease.②This article also carries out specific analysis on the mechanism of action of combined with the medical record by combining the chimeric antigen receptor(CAR)of the structure,the second generation CAR advantage,CAR-T cells resistant to tumor cells.③This paper also proves the CAR-T cells is a feasible positive method in the treatment of relapse/refractory acute lymphocytic leukemia CD19 antigen,it can remove resistant patients with malignant tumor cells in the body,even achieve complete relief,but will eventually relapses,then,how to make patients continue to achieve remission is still a problem to be solved.Now the rep
出处
《中医临床研究》
2018年第18期62-65,共4页
Clinical Journal Of Chinese Medicine
