RESUMEN
A systematic review of published articles based on randomized clinical trials was conducted to ascertain the efficacy or perspective of using CAR-T cell therapy for refractory multiple myeloma. The PubMed database was searched with the combination of terms "multiple myeloma", "refractory multiple myeloma", "CAR T-cell", and the PRISMA criteria were followed. Of the 78 articles found, only 5 were selected. The studies used different treatment protocols and four different types of CAR-T cells. All studies obtained interesting results in terms of increased progression-free survival and negative minimal residual disease responses. Some authors detected an expansion of CAR-T cells and noted dose-dependent relationship between treatment effectiveness and serum BCMA levels. Although the results were promising, a small number of patients still relapsed a few months after CAR-T cell infusion. Therefore, this new line of therapy should be further investigated, as it significantly increases progression-free survival and improves quality of life.
Uma revisão sistemática de artigos publicados com base em ensaios clínicos randomizados foi realizada para verificar a eficácia ou perspectiva do uso da terapia com células CAR-T para mieloma múltiplo refratário. Foi pesquisada a base de dados PubMed com a combinação dos termos "multiple myeloma", "refratory multiple myeloma", "CAR T-cell" e foram seguidos os critérios PRISMA. Dos 78 artigos encontrados, apenas 5 foram selecionados. Os estudos utilizaram diferentes protocolos de tratamento e quatro tipos diferentes de células CAR-T. Todos os estudos obtiveram resultados interessantes em termos de aumento da sobrevida livre de progressão e respostas negativas à doença residual mínima. Alguns autores detectaram uma expansão das células CAR-T e observaram uma relação dose-dependente entre a eficácia do tratamento e os níveis séricos de BCMA. Embora os resultados tenham sido promissores, um pequeno número de pacientes ainda apresentou recaída alguns meses após a infusão de células CAR-T. Portanto, esta nova linha de terapia deve ser mais investigada, pois aumenta significativamente a sobrevida livre de progressão e melhora a qualidade de vida.
Asunto(s)
Mieloma Múltiple , NeoplasiasRESUMEN
Aims: South Brazilian Hypericum species are a source of dimeric structures, constituted of filicinic acid and phloroglucinol moieties, which present antidepressant-like effects mediated by monoaminergic neurotransmission in rodents. Here, we show that hyperbrasilol B, a phloroglucinol derivative from Hypericum caprifoliatum, presents antidepressant-like activity in mice forced swimming test (FST). The aim of this study was to determinate if Na+ channels are important to the antidepressant-like effect of hyperbrasilol B and also verify the effect of this compound on Na+, K+ ATPase activity in the cerebral cortex and hippocampus of mice. Methodology: We assessed the effects of veratrine, a Na+ channel opener on antidepressant-like effect of hyperbrasilol B by using mice FST. Veratrine (0.06 mg/kg) and hyperbrasilol B (10 mg/kg) were given i.p. 60 and p.o. 30 min, respectively, before the test. In another batch of experiments different groups of mice were treated with hyperbrasilol B 10 mg/kg, p.o. (Single administration or once a day during 3 days). Two hours after the acute or after the last of the three treatments, the brain structures were removed for measuring Na+, K+ ATPase activity. Results: Veratrine was able to prevent the anti-immobility effect of hyperbrasilol B on the FST, suggesting that its antidepressant-like effect might be due to Na+ influx modifying properties. Animals treated for 3 consecutive days with hyperbrasilol B presented a significant increase in the hippocampus Na+, K+ ATPase activity. The acute treatment was ineffective. Conclusion: Alterations in the Na+ gradient may be implicated in the antidepressant-like effect of hyperbrasilol B.