CAR-T細胞治療的基本原理及藥理機制

Basic Principle and Pharmacological Mechanism of the Chimeric Antigen Receptor (CAR)-T Cell

嵌合抗原受體T細胞（chimeric antigen receptor T-cell, CAR-T）治療是一項針對難治與復發型血液惡性腫瘤的尖端免疫療法，近年在急性淋巴性白血病（acute lymphoblastic leukemia）與瀰漫性大B細胞淋巴瘤（diffuse large B-cell lymphoma）等疾病中展現突破性療效。治療原理為採集病人自身T細胞，透過基因工程賦予其表現CAR結構，使其具備辨識腫瘤抗原的能力。這些改造後的T細胞在回輸體內後能大量擴增、釋放細胞激素並直接誘發腫瘤細胞凋亡。CAR-T細胞的結構包含抗原辨識區、訊號傳導區與共刺激域，不同設計會影響細胞活性與毒性反應。治療流程包括病人評估、白血球分離術、基因轉殖與細胞培養、淋巴球清除性化療及CAR-T輸注，全程需跨科別團隊密切合作。常見副作用如細胞激素釋放症候群與神經毒性，需由護理人員進行監測與評估嚴重度以早期介入。此外，CAR-T治療後延遲性不良反應包含血液學毒性、免疫球蛋白低下，需長期追蹤與支持性照護。護理師在治療流程中扮演關鍵角色，需兼顧臨床監護、病人衛教與心理支持，確保療效安全並提升病人整體照護品質。

Chimeric antigen receptor T-cell (CAR-T) therapy is an advanced immunotherapy designed for the effective treatment of patients with refractory or relapsed hematologic malignancies. In recent years, CAR-T therapy has demonstrated remarkable therapeutic efficacy in applications on diseases such as acute lymphoblastic leukemia and diffuse large B-cell lymphoma. The treatment approach involves collecting a patient’s own T cells and genetically engineering them to express a CAR structure, enabling specific recognition of tumor-associated antigens. Reinfused into the patient, these modified T cells undergo robust expansion, secrete cytokines, and directly induce apoptosis in tumor cells. CAR-T cells typically comprise three domains, namely antigen-recognition, signaling, and co-stimulatory, each of which influences the activity and toxicity profile of these cells. The CAR-T cell therapy process includes patient evaluation, leukapheresis, gene transduction and cell expansion, lymphodepleting chemotherapy, and CAR-T infusion, all of which require multidisciplinary collaboration. The common adverse effects of CAR-T therapy, including cytokine release syndrome and neurotoxicity, must be closely monitored for and graded by nursing staff for early intervention. In addition, delayed toxicities such as pancytopenia or hypogammaglobulinemia may occur, necessitating long-term follow-up and supportive care. Nurses play a pivotal role throughout the CAR-T treatment process in terms of providing clinical monitoring, patient education, and psychological support; ensuring treatment safety; and optimizing overall patient care quality.