Bustamante-Ogando Juan Carlos, Hernández-López Alejandrina, Galván-Díaz César, Rivera-Luna Roberto, Fuentes-Bustos Hugo E, Meneses-Acosta Angélica, Olaya-Vargas Alberto
Immunodeficiencies Research Laboratory and Clinical Immunology Department, Instituto Nacional de Pediatría, Mexico City, Mexico.
Laboratorio 7 Biotecnología Farmacéutica, Facultad de Farmacia, Universidad Autónoma del Estado de Morelos, Universidad Autónoma del Estado de Morelos (UAEM), Cuernavaca, Morelos, Mexico.
Front Oncol. 2024 Jan 18;13:1304805. doi: 10.3389/fonc.2023.1304805. eCollection 2023.
Leukemias are the most common type of pediatric cancer around the world. Prognosis has improved during the last decades, and many patients are cured with conventional treatment as chemotherapy; however, many patients still present with a refractory disease requiring additional treatments, including hematopoietic stem cell transplantation. Immunotherapy with monoclonal antibodies or cellular therapy is a promising strategy for treating refractory or relapsed hematological malignancies. Particularly, CAR-T cells have shown clinical efficacy in clinical trials, and different products are now commercially approved by regulatory agencies in the USA and Europe. Many challenges still need to be solved to improve and optimize the potential of these therapies worldwide. Global access to cell therapy is a significant concern, and different strategies are being explored in the middle- and low-income countries. In Mexico, leukemias represent around 50% of total cancer diagnosed in pediatric patients, and the rate of relapsed or refractory disease is higher than reported in other countries, a multi-factorial problem. Although significant progress has been made during the last decades in leukemia diagnosis and treatment, making new therapies available to Mexican patients is a priority, and cell and gene therapies are on the horizon. Efforts are ongoing to make CAR-T cell therapy accessible for patients in Mexico. This article summarizes a general landscape of childhood leukemias in Mexico, and we give a perspective about the current strategies, advances, and challenges ahead to make gene and cell therapies for leukemia clinically available.
白血病是全球最常见的儿童癌症类型。在过去几十年中，白血病的预后有所改善，许多患者通过化疗等传统治疗方法得以治愈；然而，仍有许多患者患有难治性疾病，需要包括造血干细胞移植在内的额外治疗。单克隆抗体免疫疗法或细胞疗法是治疗难治性或复发性血液系统恶性肿瘤的一种有前景的策略。特别是，嵌合抗原受体T细胞（CAR-T细胞）在临床试验中已显示出临床疗效，目前不同的产品已获得美国和欧洲监管机构的商业批准。为了在全球范围内改进和优化这些疗法的潜力，仍有许多挑战需要解决。全球范围内细胞疗法的可及性是一个重大问题，中低收入国家正在探索不同的策略。在墨西哥，白血病约占儿科患者确诊癌症总数的50%，复发或难治性疾病的发生率高于其他国家报道的情况，这是一个多因素问题。尽管在过去几十年中白血病的诊断和治疗取得了重大进展，但让墨西哥患者能够获得新疗法仍是当务之急，细胞和基因疗法即将出现。目前正在努力使墨西哥患者能够接受CAR-T细胞疗法。本文总结了墨西哥儿童白血病的总体情况，并对目前使白血病的基因和细胞疗法临床可用的策略、进展和面临的挑战给出了观点。
