The body’s immune system has evolved over time to differentiate between self and non-self in a bid to protect. Since cancer originates from the body’s own cells therein lie the problem. Leukemia is a type of cancer that has its genesis in blood forming tissue. It causes the over production of abnormal white blood cells which is the part of blood that fights against infection ( Bond et al., 2016). There are a number of approaches to treating leukemia and one of the latest methods is altered T-cell therapy, where the immune cells are re-engineered to boost their effectiveness. A T cell or T lymphocyte is a type of lymphocyte that forms part of the adaptive immune system. However, researchers continue to use and invent other methods of combating cancer and these include ( Juliusson & Hough, 2016).).
Cancer vaccines that boost the immune system and eradicate cancer cell.
Check point inhibitors that prevent cancer cells form deactivating the immune systems
Monoclonal anti-bodies that are designed to identify and attack specific characteristics of cancer cells.
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The discussion will focus on T cell therapy, highlighting how it works, its success rate and side effects.
According to El-Saghir et al., (2016), T cell therapy is a complicated process that is still in the developmental stages and thus it is conducted in clinical trials at specialized facilities. This treatment is targeted towards patients that suffer predominantly from Acute Lymphocytic Leukemia (ALL) and Chronic Lymphocytic Leukemia (CLL). A T cell or T lymphocyte is a type of lymphocyte that forms part of the adaptive immune system. The most notable is CAR T cell therapy where the patient’s T cells are altered to boost the immune system’s capacity in fighting cancer cells. The modified T cells boost the immune system’s response to a particular cancerous cell antigen. Every patient that is undergoing the CAR T cell therapy gets cells that are customized just for them. The T cells are harvested from the patient’s blood through a process called apheresis and genetically reengineered in the laboratory to convert them into CAR T cells. This process requires several weeks to grow the cells and can be quite expensive.
Wilkins et al., (2017) further points out that in an effort to circumvent this problem, a new solution has been developed which is referred to as allogeneic CAR T cell therapy. Under this process, the cells are sourced from a healthy donor. The CAR in T cell is an acronym for Chimeric Antigen Receptor. Chimeric refers to the different components used to engineer the T cell. Antigen denotes the protein on the cancer cell that the T cell is designed to target .Receptor is what is added to the surface of the T cell whose function is to search for the matching antigen on the cancer cell, identify it and destroy it.
The CAR T cells are developed in a laboratory and when the patient is ready they are imparted back into the patient. In some cases the patient receives a little chemotherapy before the CAR T treatment starts in order to eliminate other immune cells in the body. The purpose of this is to give the new cells more operating room. Once they have been introduced to the blood stream, the cells tend to remain active for a long period, even several years and thus it is a one-time treatment. T-cell therapy is usually done on patients with blood cancer like lymphoma and leukemia, both in children and adults ( Bond et al., 2016).
The treatment takes advantage of how the immune system works by tweaking it and directing a spotlight towards the infected cells. The immune system works by identifying, alien, unusual or deadly substances in our bodies and can, therefore, distinguish between healthy cells and abnormal cells like cancerous ones. The differences that they will identify are known as antigens which are proteins that coat the surface of cells. The CAR T cells are designed to look for a very particular target on the surface of a cell which they can then identify and destroy. Unlike viruses or bacteria that attack the body from the outside, cancer cells originate from our very own tissues and organs, and they often resemble healthy cells ( Grady, 2012). )
The CAR T cell therapy identifies targets that the engineered cells can destroy with minimal damage to healthy cells. Scientists of CAR T cell therapy have been able to identify most of the targets on cancers that begin in B cells including some acute and chronic leukemias and several types of non-Hodgkin lymphomas. The aforementioned is because B cells are healthy cells that are part of the immune system. The most obvious target for CAR T-cell therapy is a protein found in both normal and cancerous B cells. Therefore CAR T cells attack both the normal and malignant B cells (Wang et al., 2017).
Most of the patients who resort to this alternative method of treatment are those that do not have any other option. They have tried different treatments that have stopped working for them. It goes without saying that not all patients respond to this treatment. More that eighty percent of children diagnosed with acute lymphoblastic leukemia will get well through intensive chemotherapy. If cancer comes back after such rigorous treatment, viable options are close to none. Although clinical trials have reported impressive results in treating the most severe forms of cancer, it also has its drawbacks ( Juliusson & Hough, 2016 ).
CAR T-cell therapy may entail various critical sides to one’s health including nausea, fever, muscle aches. Sometimes these effects may escalate to severe conditions such as neuro-toxicity and cytokine release syndrome, thus become life-threatening. The treatment, therefore, has to be conducted in a fully equipped hospital with a full medical team assigned to monitor and manage the patient. The more cancer one has in the body, the higher the risk involved. Cytokine release syndrome poses the greatest danger. It is a result the growth of re-engineered T Cells in the bloodstream which releases a lot of cytokines into the system. It leads to dangerously high fevers and instantaneous drops in blood pressure ( Peng & Li, 2016).
The worst symptoms are experienced in the initial stages of treatment when the patient has more cancer. It then follows that patients with more cancer in their bodies will experience more severe side effects which will lessen as the cancerous cells go down. Unfortunately, in addition to targeting the cancerous B cells, the modified cells also target healthy B cells. It leads to B cell aplasia which is the condition of little or no B cells. It can be managed by intravenous immunoglobulin replacement to help prevent infection ( McCarrier et al., 2016).
The good news is patients who respond to the treatment and can overcome the side effects mostly have few or no complications and go on to live wholesome lives. Preliminary results are positive and if the treatment is FDA approved, the cost per patient will be significantly less as compared to a bone marrow transplant. Another advantage of the CAR T cells is that they remain in the body long after the infusion which means they will offer protection against resurgence (Wang et al., 2017).
Conclusion
Leukemia cells often use a number strategies to escape the host immune system, including attacking and weakening the immunogenicity of the target antigen. T-cells play a crucial role in enhancing cell-mediated immunity and therefore, recent strategies such as genetically altered T-cells have made significant advances. However, although the advances in technology have improved the efficacy of such treatments, modified T-cell immunotherapy still remains a challenge. The challenges are varied, ranging from identification of key antigen targets and with existing regulatory safety issues to fruitfully navigating the ways to commercial development. However, the encouraging scientific studies on understanding of leukemia immunology and the enhancements in the production of T-cell products are all enhancing the clinical transition of this critical cellular immunotherapy.
References
Bond, J., Marchand, T., Touzart, A., Cieslak, A., Trinquand, A., Sutton, L., Radford-Weiss, I., ... Asnafi, V. (2016). An early thymic precursor phenotype predicts outcome exclusively in HOXA-overexpressing adult T-cell acute lymphoblastic leukemia: a Group for Research in Adult Acute Lymphoblastic Leukemia study. Haematologica, 101, 6, 732-40.
El-Saghir, Jamal, Nassar, Farah, Tawil, Nadim, & El-Sabban, Marwan. (2016). ATL-derived exosomes modulate mesenchymal stem cells: potential role in leukemia progression . BioMed Central Ltd.
Grady, D. (2012). In Girl’s Last Hope, Altered Immune Cells Beat Leukemia. New York Times Reports, 1.
Juliusson, G., & Hough, R. (2016). Leukemia. Progress in Tumor Research, 43, 87-100.
McCarrier, K. P., Bull, S., Fleming, S., Simacek, K., Wicks, P., Cella, D., & Pierson, R. (2016). Concept Elicitation Within Patient-Powered Research Networks: A Feasibility Study in Chronic Lymphocytic Leukemia. Value in Health : the Journal of the International Society for Pharmacoeconomics and Outcomes Research, 19, 1, 42-52.
Peng, C., & Li, S. (2016). Chronic Myeloid Leukemia (CML) Mouse Model in Translational Research. Methods in Molecular Biology (clifton, N.j.), 1438, 225-43.
Wilkins, O., Keeler, A. M., & Flotte, T. R. (2017). CAR T-Cell Therapy: Progress and Prospects. Human Gene Therapy Methods, 28, 2, 61-66.
