Genetically enhanced T lymphocytes and the intensive care unit

// Tiberiu Tat 1, 2 , Huming Li 3 , Catalin-Sorin Constantinescu 1, 4 , Anca Onaciu 5 , Sergiu Chira 5 , Ciprian Osan 5 , Sergiu Pasca 5 , Bobe Petrushev 5 , Vlad Moisoiu 5 , Wilhelm-Thomas Micu 5 , Cristian Berce 6 , Sebastian Tranca 2 , Delia Dima 7 , Ioana Berindan-Neagoe 5 , Jianliang Shen 8 , Ciprian Tomuleasa 7, 9 and Liren Qian 8 1 Intensive Care Unit, Ion Chiricuta Clinical Cancer Research, Cluj Napoca, Romania 2 Department of Anesthesiology-Intensive Care, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj Napoca, Romania 3 Department of Pulmonary and Critical Care Medicine, Navy General Hospital of PLA, Beijing, China 4 Department of Hematology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj Napoca, Romania 5 Research Center for Functional Genomics and Translational Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj Napoca, Romania 6 Department of Experimental Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj Napoca, Romania 7 Department of Hematology, Ion Chiricuta Clinical Cancer Research, Cluj Napoca, Romania 8 Department of Hematology, Navy General Hospital of PLA, Beijing, China 9 Research Center for Functional Genomics and Translational Medicine / Hematology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj Napoca, Romania Correspondence to: Ciprian Tomuleasa, email: ciprian.tomuleasa@umfcluj.ro Keywords: hematological malignancies; chimeric antigen receptor-modified T cell; donor lymphocyte infusion; stem cell transplant; immunotherapy Received: December 01, 2017      Accepted: February 26, 2018      Published: March 27, 2018 ABSTRACT Chimeric antigen receptor-modified T cells (CAR-T cells) and donor lymphocyte infusion (DLI) are important protocols in lymphocyte engineering. CAR-T cells have emerged as a new modality for cancer immunotherapy due to their potential efficacy against hematological malignancies. These genetically modified receptors contain an antigen-binding moiety, a hinge region, a transmembrane domain, and an intracellular costimulatory domain resulting in lymphocyte T cell activation subsequent to antigen binding. In present-day medicine, four generations of CAR-T cells are described depending on the intracellular signaling domain number of T cell receptors. DLI represents a form of adoptive therapy used after hematopoietic stem cell transplant for its anti-tumor and anti-infectious properties. This article covers the current status of CAR-T cells and DLI research in the intensive care unit (ICU) patient, including the efficacy, toxicity, side effects and treatment.