Immunotherapy of Acute Lymphoblastic Leukemia in Pediatrics

One of the most important and common malignant hematological cancers in children is Acute Lymphoblastic Leukemia (ALL), which is the fifth most common childhood cancer that occurs due to the uncontrolled proliferation of primary lymphoid precursors that infiltrate the bone marrow. This disease occurs in both adults and children, but it is more common in children. The effective factors that play a role in the occurrence of this disease are classified into two categories: genetic and environmental. Environmental factors include childhood infections, ionizing radiation, exposure to pesticides, and genetic factors such as various genetic mutations, chromosome translocations, cell cycle regulation disorders, and genetic diseases such as ataxia telangiectasia or Down syndrome are important in causing this disease. Among the conventional treatments, we can mention chemotherapy, which has adverse effects in the long term. As a result, molecular-based therapies and personalized medicine, such as targeted drugs and immunotherapy, which cause fewer side effects,.In immunotherapy, we can mention the treatment of monoclonal antibodies, NK therapy, CAR-T cell therapy. Materials and Methods: Searched in ۳ databases; PubMed, Scopus and Web of Science with the related terminology of Immunotherapy, pediatric and leukemia. Also, relevant articles from ۲۰۲۰ until now are reviewed to mention immunotherapy for leukemia. Result: Chimeric T cells are called CAR-T cell and are made by performing a series of genetic engineering techniques. The research results show that the autologous treatment of tuberculosis targeting CD۱۹ marker in a clinical trial that included patients from children to young adults with a recovery rate of ۶۲ to ۹۳% is one of the important signs of the remarkable success of this type of modern treatment method. This study was in the case that the response of the immune system of these patients was about one month after receiving this type of treatment. Other studies show that performing HSCT after treatment with CAR-T cell therapy bypass can reduce the rate of disease recurrence and malignancy to less than ۱۰% in ۲۴ months, which shows the importance of combined therapy and cardiopulmonary bypass alone is not enough. Conclusion: CAR-T cell therapy, despite its many successes so far, especially in the treatment of ALL, has complications, challenges, and limitations, the most important of which are the longevity of t cells, antigen escape, neurotoxicity, and very high treatment prices pointed out.

کلیدواژه ها:

Immunotherapy ، acute lymphoblastic leukemia ، pediatric ، CAR-T cell therapy