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Review
. 2021 Aug 20;12(1):465.
doi: 10.1186/s13287-021-02420-8.

Novel CAR T therapy is a ray of hope in the treatment of seriously ill AML patients

Affiliations
Review

Novel CAR T therapy is a ray of hope in the treatment of seriously ill AML patients

Faroogh Marofi et al. Stem Cell Res Ther. .

Abstract

Acute myeloid leukemia (AML) is a serious, life-threatening, and hardly curable hematological malignancy that affects the myeloid cell progenies and challenges patients of all ages but mostly occurs in adults. Although several therapies are available including chemotherapy, allogeneic hematopoietic stem cell transplantation (alloHSCT), and receptor-antagonist drugs, the 5-year survival of patients is quietly disappointing, less than 30%. alloHSCT is the major curative approach for AML with promising results but the treatment has severe adverse effects such as graft-versus-host disease (GVHD). Therefore, as an alternative, more efficient and less harmful immunotherapy-based approaches such as the adoptive transferring T cell therapy are in development for the treatment of AML. As such, chimeric antigen receptor (CAR) T cells are engineered T cells which have been developed in recent years as a breakthrough in cancer therapy. Interestingly, CAR T cells are effective against both solid tumors and hematological cancers such as AML. Gradually, CAR T cell therapy found its way into cancer therapy and was widely used for the treatment of hematologic malignancies with successful results particularly with somewhat better results in hematological cancer in comparison to solid tumors. The AML is generally fatal, therapy-resistant, and sometimes refractory disease with a disappointing low survival rate and weak prognosis. The 5-year survival rate for AML is only about 30%. However, the survival rate seems to be age-dependent. Novel CAR T cell therapy is a light at the end of the tunnel. The CD19 is an important target antigen in AML and lymphoma and the CAR T cells are engineered to target the CD19. In addition, a lot of research goes on the discovery of novel target antigens with therapeutic efficacy and utilizable for generating CAR T cells against various types of cancers. In recent years, many pieces of research on screening and identification of novel AML antigen targets with the goal of generation of effective anti-cancer CAR T cells have led to new therapies with strong cytotoxicity against cancerous cells and impressive clinical outcomes. Also, more recently, an improved version of CAR T cells which were called modified or smartly reprogrammed CAR T cells has been designed with less unwelcome effects, less toxicity against normal cells, more safety, more specificity, longer persistence, and proliferation capability. The purpose of this review is to discuss and explain the most recent advances in CAR T cell-based therapies targeting AML antigens and review the results of preclinical and clinical trials. Moreover, we will criticize the clinical challenges, side effects, and the different strategies for CAR T cell therapy.

Keywords: Acute myeloid leukemia; Adoptive cell therapy; Chimeric antigen receptor T cells; Hematological malignancy; Target antigen.

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Conflict of interest statement

There is no conflict of interest.

Figures

Fig. 1
Fig. 1
Isolation, engineering, proliferation, and administration of CAR T cells. In the first stage, T cells are isolated from patients through leukapheresis and then harvested and activated. After that, the engineering and construction of the CARs are done in T cells. After the proliferation of the produced CAR T cells, the cells are re-injected into patients
Fig. 2
Fig. 2
Different generations of CAR T cells. CAR signaling and applications are updated with each new generation. The first generation consists of an intracellular domain (CD3ζ chain), the second generation of CAR T cells has been composed of the addition of CD28 to CD3 as co-stimulatory molecules. In the third generation of CAR T cells, OX-40, a second co-stimulatory molecule, has been added. In the fourth generation, NFAT has been added to the induction of cassette containing the IL-12 gene promoter. NFAT, nuclear factor of activated T cells
Fig. 3
Fig. 3
Implications of the association between the CAR T cell and cancer cells in AML. The production of a CAR T cell in patients with AML leads to its identification and binding to TAAs or TSAs on the surface of the cancer cell and has a variety of effects, including activation of macrophages to produce ROS and NOS, activation of NK cells to secrete perforin and granzyme, and secretion of cytokines that strengthen the body’s immune system, which eventually kills tumor cells

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