Immunotherapy

Immunotherapy is a type of biological therapy that uses substances made by living organisms to treat cancer. It is a treatment that helps the immune system in which T cells (type of immune cell) are administered to the patient to help him fight cancer.

During cancer treatment, T cells are obtained from the patient’s blood or tumor tissue, large numbers of copies of these cells are made in the laboratory, and modified in the laboratory to improve their ability to target cancer cells. and they are returned to the patient to help the immune system fight cancer.

Adoptive cellular immunotherapy with donor T cells is being studied in the treatment of some types of cancer and some infections. Also called adoptive cell therapy, T-cell transfer therapy, and adoptive cell transfer.

Types of immunotherapy

Some of the types of immunotherapy that can be used to treat cancer are:

• T cell transfer therapy is a treatment that strengthens the natural ability of T cells to fight cancer. Cells that are most active against cancer are selected or changed in the laboratory to better attack cancer cells, multiply in larger groups, and are returned to the body through an infusion.

T-cell transfer therapy may also be called adoptive cell therapy, adoptive immunotherapy, or immune cell therapy.

And types of adoptive cell immunotherapy include chimeric antigen receptor T-cell therapy (CAR T-cell therapy) and tumor infiltrating lymphocyte (LIT) therapy.

• Immune checkpoint inhibitors: These are drugs that block immune checkpoints.
• Monoclonal antibodies are immune system proteins created in the laboratory for the purpose of binding to specific targets on cancer cells. Some monoclonal antibodies mark cancer cells so that they can be better seen and destroyed by the immune system.
• Cancer treatment vaccines work by strengthening the immune system’s response against cancer cells.
• Immunomodulators are substances that enhance the body’s immune response against cancer.

For years, the bases of cancer treatment were surgery, chemotherapy and radiotherapy. However, in recent years, immunotherapy, or therapies that condition and strengthen a patient’s immune system to attack tumors, has emerged as what many in the oncology community now call the “fifth column” of cancer treatment. .

Research is ongoing to understand why immunotherapy is effective in some patients, but not in others who have the same cancer. Likewise, on how to extend the use of immunotherapy to more types of cancer, and increase the effectiveness of immunotherapy by combining it with other types of cancer treatment, such as those mentioned, such as targeted therapy, chemotherapy and radiotherapy.

Explanatory video:

https://youtu.be/pj-9xg6djdQ

https://youtu.be/CwaMZCu4kpI

Reference:

https://www.cancer.gov/espanol/cancer/tratamiento/investigacion/celulas-t-y-car

https://www.mdanderson.org/cancerwise/what-is-tumor-infiltrating-lymphocyte-til-therapy–6-things-to-know.h00-159460056.html

https://www.cancer.gov/about-cancer/treatment/types/immunotherapy

Cell markers – Immunotherapy

Cancer types are encompassed by cellular or molecular markings, which are feasible for treatment by cellular immunotherapy. Immunolabels are the molecules that are expressed in the different types of cancer cells, in this way we identify the cells to which the therapy is directed.

ROR-1+

• Kidney cancer
• Chronic lymphocytic leukemia
• Melanoma
• Lung adenocarcinoma

ErbB-2+ (HER-2/neu)

• Breast cancer
• Ovarian cancer
• Prostate cancer

T cells with CAR (CAR T-cell)

Car-T Cells therapy is another type of adoptive cell therapy. It is a type of treatment in which the patient’s T cells (a type of immune system cell) are modified in the laboratory so that they can find and destroy cancer cells. The T cells are taken from the patient’s blood, and in the laboratory, the special synthetic receptor gene that binds to a certain protein on the patient’s cancer cells is added. This special receptor is called the chimeric antigen receptor (CAR). Large numbers of CAR T cells are produced in the laboratory and administered to the patient by infusion. CAR T-cell therapy is used to treat certain cancers of the blood, and is being studied in the treatment of other types of cancer.

Since different types of cancer have different antigens, each CAR is made for the specific antigen of a cancer. For example, in certain types of leukemia or lymphoma, the cancer cells contain an antigen on the outside of the cancer cells called CD19. CAR-T cell therapies to treat these cancers are designed to bind to the CD-19 antigen and will not work against a cancer that does not contain the CD19 antigen.

Reference:

https://pubmed.ncbi.nlm.nih.gov/20668228/

https://videocast.nih.gov/Summary.asp?file=19892&bhcp=1

https://www.mdanderson.org/treatment-options/car-t-cell-therapy.html

Hematopoietic stem cell collection

Stem cells are the raw material of the body; They are special cells that can reproduce themselves and become the different types of cells that the body needs with specialized functions.

Both cancer and cancer treatment can damage hematopoietic stem cells. Hematopoietic stem cells are stem cells that turn into blood cells; and they can be collected from these three different sources:

Bone marrow cells

Peripheral blood cells

Umbilical cord blood cells

Stem cell collection using bone marrow

Bone marrow is a soft, spongy tissue in the body that contains hematopoietic stem cells. It is a procedure that is performed in the operating room, under general anesthesia with the aim that the donor does not feel pain. The marrow cells are harvested from the posterior iliac crest (the upper back part of the pelvic or hip bone); and from the center of this bone, the liquid marrow is extracted. The amount obtained will depend on the weight of the donor, normally around 10% of the bone marrow is extracted, in an average period of 90 minutes. The body will replace these cells in 4-6 weeks.

There are few risks to the donor, and serious complications occur very rarely. However, bone marrow donation is a surgical procedure, and rare complications may include reactions to anesthesia, infection, nerve or muscle damage, transfusion reactions (if a blood transfusion is required). blood transfusion) or injury to the site where the marrow was obtained.

Most donors return to their daily activities after two to three days. But feeling completely normal may take two to three weeks.

Stem cell collection using peripheral blood

The donor is stimulated several days before the cell collection with a drug to stimulate the bone marrow to produce more stem cells in the blood. During those days, the donor may present some side effects or discomfort such as: bone pain, headache, nausea, sleep problems, mild fevers and fatigue. These effects disappear once the injections are finished and the collection is finished, and can regularly be treated with pain relievers.

On the day of the procedure or collection, the donor’s blood is drawn through a catheter that is placed in one of the veins in the arm. There will be times when a subclavian or jugular central catheter will need to be placed, depending on the evaluation and evaluation of your veins. The blood passes through a machine that separates the stem cells from the rest of the blood cells through a process called apheresis which takes approximately 5-7 hours and is an outpatient procedure.

Umbilical cord blood cell collection

Umbilical cord blood is the blood that remains in the placenta and umbilical cord after the birth of a baby. This process of collecting cells does not present any risk to the baby or the mother. Cord blood transplantation uses blood that would otherwise be discarded. The cord blood containing the stem cells is placed in a specific container and cryopreserved or frozen until required.

Bone marrow transplant

Bone marrow transplantation is a medical treatment that replaces the bone marrow with healthy cells. These cells to be used for replacement may come from your own body or from a donor.

We collaborate with expert and certified doctors to perform transplantation and infusion of stem cells of bone marrow origin, and of peripheral blood.

A stem cell transplant is also known as a bone marrow transplant. Transplantation can be used to treat certain types of cancer such as leukemia, myeloma, and lymphoma, and other diseases of the blood, immune system, metabolic, and that affect the bone marrow.

There are two stem cell / bone marrow transplant options:

Autologous transplant. The stem cells for an autologous transplant come from the same patient. Cancer is sometimes treated with a high dose of intensive chemotherapy or radiation therapy. This type of treatment can damage stem cells and your immune system. So doctors remove, or rescue, your stem cells from your blood or bone marrow before cancer treatment begins.

Allogeneic transplantation. The stem cells for an allogeneic transplant come from another person, called a donor, either relative or unknown, and this must be compatible with the patient, in the HLA (human leukocyte antigens, for its acronym in English). To find out if there is compatibility, an HLA typing is performed. If your donor’s proteins match yours, you are less likely to have a serious side effect called graft-versus-host disease (GVHD). In this disease, healthy cells from the transplant attack your cells.

https://www.cancer.net/es/desplazarse-por-atenci%C3%B3n-del-c%C3%A1ncer/c%C3%B3mo-se-trata-el-c%C3%A1ncer/qu%C3%A9-es-el-trasplante-de-c%C3%A9lulas-madre-trasplante-de-m%C3%A9dula-%C3%B3sea

Psycho-emotional Accompaniment

The disease has a significant emotional impact on patients and on people in their emotional environment. In this context, people tend to suffer emotionally, and good care takes care of the emotional aspects and gives tools to act appropriately.

Communication, knowing oneself and emotional support are key aspects for the care of patients during their treatment. This therapeutic relationship must always be professional to be able to provide tools when dealing with pain, anguish, suffering and uncertainty.

The respectful emotional accompaniment is based on supporting the emotional experience of another person from the active presence, reflecting to the other what we understand about their emotional experience, letting them fully manifest the experience of the emotion, showing our company and understanding, without trying to manage it for the other, that is, respecting their personal process and time.

Nutritional Support

Food is one of the key tools for the physical well-being of a person; and even more so in the defense against some types of cancer, because although this disease sometimes has a genetic origin, in many cases it can be due to other external factors.

The nutritional guidance and support service consists of evaluating the physical state and eating habits of the patient, to issue a nutritional diagnosis and make the necessary recommendations to prevent, treat and eradicate diseases related to food.

The objective of this service is to provide information to promote healthy eating habits that improve the conditions of the patient with the disease.

Hospitalization and departure of cells or derivatives

We have the experience, equipment, permits and licenses necessary to carry out the management of export and import of cells and derivatives to facilitate the transplantation of stem cells where the patient is.

Stem cell cryopreservation

Cryopreservation is the use of temperatures between -80 ° C and -196 ° C for the intact conservation of living biological cells and tissues with the aim of totally blocking cellular enzyme systems allowing, in theory, their indefinite conservation, for later recovery after thawing.

The best known cryopreservation technique is immersion in liquid nitrogen. This cryoprotective element allows not so much intracellular fluid to be lost during cooling and at the same time maintains a sufficient concentration of solutes to reduce the appearance of intracellular crystals. As long as storage is kept at a stable temperature, it does not interfere with the viability of the cells.

Counts and diagnostic tests

Flow cytometry

In order to diagnose certain diseases such as leukemia and lymphomas, an immunophenotyping or immunophenotyping test is performed. For this, a machine is used that analyzes certain substances (such as markers) that are on or in the cells and that helps to identify the types of cells they are and their characteristics. This test is done using a technique called flow cytometry, and it is the most important test to confirm a diagnosis of CLL.