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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Chimeric antigen receptor &#40;CAR&#41; T-cell immunotherapy poses a significant challenge to the public health system and in the management of blood cancers&#46; The article &#8220;Immunotherapy with CAR T-cells in paediatric haematology-oncology&#8221;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">1</span></a> by the Group on Immunotherapy and Advanced Therapies of the Sociedad Espa&#241;ola de Hematolog&#237;a y Oncolog&#237;a Pedi&#225;tricas &#40;Spanish Society of Paediatric Haematology and Oncology&#41; provides an interesting review of the most relevant aspects of the introduction of immunotherapy with T cells expressing a chimeric antigen receptor &#40;CAR&#41; in the therapeutic armamentarium against CD19&#43; B cell lymphoproliferative disorders&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">CAR T-cells are T cells that have been genetically engineered to express a receptor that targets a tumour antigen&#46; Thus&#44; the CAR T cell can attack and destroy the tumour cell without the mediation of the human leucocyte antigen &#40;HLA&#41; complex &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; CAR T-cells that target the B-lymphocyte antigen CD19 &#40;CART-19&#41; can eliminate tumour cells in B-cell lymphomas and leukaemias&#46; It is precisely in paediatric patients with very advanced B-cell acute lymphoblastic leukaemia and few therapeutic options that CAR T-cells have proven most efficacious&#46; And it was an international clinical trial&#44; with participation of a Spanish hospital&#44; in children and young adults with acute lymphoblastic leukaemia&#44; that led to the marketing authorisation of tisagenlecleucel&#44; one of the existing commercial CAR T-cell products&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">2</span></a> In Spain&#44; CART-19 therapies are also developed in the academic setting&#44;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">3</span></a> and there is a phase I clinical trial underway in adult and paediatric patients the results of which are to be published soon&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">The authorisation by regulatory agencies of tisagenlecleucel and axicabtagene ciloleucel &#40;the 2 commercial CD19-targeting CAR T-cell products manufactured for treatment of B-cell acute lymphoblastic leukaemia in children and young adults and diffuse large B cell lymphoma in adults&#41; motivated the development and implementation of the National Plan for Advanced Therapies-CAR T-cell therapies in Spain&#46; This plan not only underscored the importance of identifying the best-suited facilities for the administration of these therapies&#44; but placed particular emphasis on the need for restructuring in some of these hospitals so that in-house manufacturing of this type of individualised immunotherapies can be integrated in their care delivery&#46; Hospitals specialised in paediatric haematology and oncology thus face the challenge of evolving towards a care delivery model that includes this gene and cellular therapy&#44; aiming to develop the capacity to manage every aspect involved in the use&#44; manufacture and administration of these novel treatments in house&#46; In this regard&#44; the development in Spain of an academic CAR T-cell therapy and a clinical trial with adult and paediatric patients has proven the viability of this type of therapy in our country&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">3</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">In addition to describing what CAR T-cells are&#44; how they work and the importance of understanding their clinical performance&#44; the article delves into aspects that are essential for their use in clinical practice&#46; One of the most specific aspects addressed in the article is the essential need for the collaboration and coordination of multiple hospital-based care specialities&#44; a concept comprehended in what the authors refer to as <span class="elsevierStyleItalic">multidisciplinary CAR T-cell team</span>&#46; While the list may seem long &#40;haematologists&#44; immunologists&#44; intensive care specialists&#44; paediatricians&#44; neurologists&#44; oncologists&#44; biologists&#44; pharmacologists&#44; hospital pharmacists&#44; experts in regulation and quality assurance systems&#44; nurses&#44; etc&#46;&#41;&#44; more than 1 year after the introduction of this management approach it has become evident that all of these actors are essential to provide effective and efficient care to patients&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">The article also addresses the option of direct in-house &#40;&#8220;academic&#8221;&#41; manufacturing and management of these therapeutic approaches&#44; in which there is a vast opportunity for ongoing improvement that should be realised&#46; The current regulation on medicinal products seeks to stabilise production systems&#44; but as is the case with most gene and cellular therapies&#44; CAR T-cell therapies require rapid adaptation to offer the most beneficial treatment options&#46; It is important to establish mechanisms for the introduction of improvements &#40;which are nearly limitless in advanced therapies&#41;&#44; and optimisation of cellular therapy can only occur if manufacturing and trials are feasible in academic settings&#46; Therefore&#44; it is important to equip hospitals with the necessary human and material resources and to develop more specific regulation that rather than obstruct will allow this &#8220;manufacture and development&#8221; of academic projects that will open access to new CAR-based immunotherapies&#46; The academic setting allows a more agile honing and innovation of CARs&#44; implementation of new protocols for manufacture and management and definition of specific clinical strategies that will more rapidly and conclusively identify the most efficacious therapeutic options for patients&#46; In addition&#44; it can conduct research on CARs for treatment of less prevalent diseases&#44; such as cancer in the paediatric age group&#44; in which the pharmaceutical industry may have less interest&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Last of all&#44; aside from any economic considerations regarding CAR T-cell therapy that could have a negative impact in universal public health systems like the one in Spain&#44; &#8220;bedside&#8221; biopharmaceutical development offers other important advantages&#46; On one hand&#44; it facilitates management of the treatment process&#44; as in-house manufacture of CAR T-cells can reduce production times&#44; an essential factor in patients with advanced cancer&#46; It also reduces the carbon footprint compared to commercial CAR T-cell products as it cuts the CO<span class="elsevierStyleInf">2</span> emissions resulting from the transport of cells between the prescribing hospital and the commercial manufacturing facility&#44; which may be separated by thousands of kilometres&#46; On the other hand&#44; local manufacture can also be important in the context of crises like the COVID-19 pandemic&#44; which is currently putting many oncological patients at extreme risk&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">4</span></a> Long-distance connection and communication difficulties place a significant strain on care delivery through a host of different problems&#44; including supply shortages when products are manufactured far from the patient&#46; Decentralised in-house processes&#44; such as academic CAR T-cell projects&#44; offer a flexibility that&#44; in the context of a crisis like the one we are currently facing&#44; could and should facilitate access to these therapies that are used as a last resort in patients facing a life-or-death situation&#44; which obviously has unique connotations when it comes to paediatric patients&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">CAR T-cells constitute a revolutionary and highly significant advance in the treatment of some blood cancers&#46; Research can identify new targets and mechanisms to combat the significant barriers that currently hinder their use in other types of solid tumours and could open up a new approach to the treatment of cancer and possibly other disorders&#44; such as autoimmune diseases&#46; The constitution of an immunotherapy group in the framework of the Sociedad Espa&#241;ola de Hematolog&#237;a y Oncolog&#237;a Pedi&#225;trica is a very significant step towards ensuring rapid access to these therapies for paediatric patients&#46;</p></span>"
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                            4 => "J&#46;M&#46; Moraleda"
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Editorial
CAR-T immunotherapy in paediatric haemato-oncology… present and future
Inmunoterapia CAR-T en hemato-oncología pediátrica… presente y futuro
Manel Juana,b,c,
Corresponding author
mjuan@clinic.cat

Corresponding author.
, Susana Rivesa,d
a Hospital Sant Joan de Déu, Plataforma de Inmunoterapia Celular SJD-Clínic, Barcelona, Spain
b Hospital Clínic de Barcelona, Barcelona, Spain
c Universitat de Barcelona, IDIBAPS, Plataforma BST-Clínic, Barcelona, Spain
d Institut de Recerca Hospital Sant Joan de Déu de Barcelona (IRP-HSJD), Barcelona, Spain
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Thus&#44; the CAR T cell can attack and destroy the tumour cell without the mediation of the human leucocyte antigen &#40;HLA&#41; complex &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; CAR T-cells that target the B-lymphocyte antigen CD19 &#40;CART-19&#41; can eliminate tumour cells in B-cell lymphomas and leukaemias&#46; It is precisely in paediatric patients with very advanced B-cell acute lymphoblastic leukaemia and few therapeutic options that CAR T-cells have proven most efficacious&#46; And it was an international clinical trial&#44; with participation of a Spanish hospital&#44; in children and young adults with acute lymphoblastic leukaemia&#44; that led to the marketing authorisation of tisagenlecleucel&#44; one of the existing commercial CAR T-cell products&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">2</span></a> In Spain&#44; CART-19 therapies are also developed in the academic setting&#44;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">3</span></a> and there is a phase I clinical trial underway in adult and paediatric patients the results of which are to be published soon&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">The authorisation by regulatory agencies of tisagenlecleucel and axicabtagene ciloleucel &#40;the 2 commercial CD19-targeting CAR T-cell products manufactured for treatment of B-cell acute lymphoblastic leukaemia in children and young adults and diffuse large B cell lymphoma in adults&#41; motivated the development and implementation of the National Plan for Advanced Therapies-CAR T-cell therapies in Spain&#46; This plan not only underscored the importance of identifying the best-suited facilities for the administration of these therapies&#44; but placed particular emphasis on the need for restructuring in some of these hospitals so that in-house manufacturing of this type of individualised immunotherapies can be integrated in their care delivery&#46; Hospitals specialised in paediatric haematology and oncology thus face the challenge of evolving towards a care delivery model that includes this gene and cellular therapy&#44; aiming to develop the capacity to manage every aspect involved in the use&#44; manufacture and administration of these novel treatments in house&#46; In this regard&#44; the development in Spain of an academic CAR T-cell therapy and a clinical trial with adult and paediatric patients has proven the viability of this type of therapy in our country&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">3</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">In addition to describing what CAR T-cells are&#44; how they work and the importance of understanding their clinical performance&#44; the article delves into aspects that are essential for their use in clinical practice&#46; One of the most specific aspects addressed in the article is the essential need for the collaboration and coordination of multiple hospital-based care specialities&#44; a concept comprehended in what the authors refer to as <span class="elsevierStyleItalic">multidisciplinary CAR T-cell team</span>&#46; While the list may seem long &#40;haematologists&#44; immunologists&#44; intensive care specialists&#44; paediatricians&#44; neurologists&#44; oncologists&#44; biologists&#44; pharmacologists&#44; hospital pharmacists&#44; experts in regulation and quality assurance systems&#44; nurses&#44; etc&#46;&#41;&#44; more than 1 year after the introduction of this management approach it has become evident that all of these actors are essential to provide effective and efficient care to patients&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">The article also addresses the option of direct in-house &#40;&#8220;academic&#8221;&#41; manufacturing and management of these therapeutic approaches&#44; in which there is a vast opportunity for ongoing improvement that should be realised&#46; The current regulation on medicinal products seeks to stabilise production systems&#44; but as is the case with most gene and cellular therapies&#44; CAR T-cell therapies require rapid adaptation to offer the most beneficial treatment options&#46; It is important to establish mechanisms for the introduction of improvements &#40;which are nearly limitless in advanced therapies&#41;&#44; and optimisation of cellular therapy can only occur if manufacturing and trials are feasible in academic settings&#46; Therefore&#44; it is important to equip hospitals with the necessary human and material resources and to develop more specific regulation that rather than obstruct will allow this &#8220;manufacture and development&#8221; of academic projects that will open access to new CAR-based immunotherapies&#46; The academic setting allows a more agile honing and innovation of CARs&#44; implementation of new protocols for manufacture and management and definition of specific clinical strategies that will more rapidly and conclusively identify the most efficacious therapeutic options for patients&#46; In addition&#44; it can conduct research on CARs for treatment of less prevalent diseases&#44; such as cancer in the paediatric age group&#44; in which the pharmaceutical industry may have less interest&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Last of all&#44; aside from any economic considerations regarding CAR T-cell therapy that could have a negative impact in universal public health systems like the one in Spain&#44; &#8220;bedside&#8221; biopharmaceutical development offers other important advantages&#46; On one hand&#44; it facilitates management of the treatment process&#44; as in-house manufacture of CAR T-cells can reduce production times&#44; an essential factor in patients with advanced cancer&#46; It also reduces the carbon footprint compared to commercial CAR T-cell products as it cuts the CO<span class="elsevierStyleInf">2</span> emissions resulting from the transport of cells between the prescribing hospital and the commercial manufacturing facility&#44; which may be separated by thousands of kilometres&#46; On the other hand&#44; local manufacture can also be important in the context of crises like the COVID-19 pandemic&#44; which is currently putting many oncological patients at extreme risk&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">4</span></a> Long-distance connection and communication difficulties place a significant strain on care delivery through a host of different problems&#44; including supply shortages when products are manufactured far from the patient&#46; Decentralised in-house processes&#44; such as academic CAR T-cell projects&#44; offer a flexibility that&#44; in the context of a crisis like the one we are currently facing&#44; could and should facilitate access to these therapies that are used as a last resort in patients facing a life-or-death situation&#44; which obviously has unique connotations when it comes to paediatric patients&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">CAR T-cells constitute a revolutionary and highly significant advance in the treatment of some blood cancers&#46; Research can identify new targets and mechanisms to combat the significant barriers that currently hinder their use in other types of solid tumours and could open up a new approach to the treatment of cancer and possibly other disorders&#44; such as autoimmune diseases&#46; The constitution of an immunotherapy group in the framework of the Sociedad Espa&#241;ola de Hematolog&#237;a y Oncolog&#237;a Pedi&#225;trica is a very significant step towards ensuring rapid access to these therapies for paediatric patients&#46;</p></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Juan M&#44; Rives S&#46; Inmunoterapia CAR-T en hemato-oncolog&#237;a pedi&#225;trica&#8230; presente y futuro&#46; An Pediatr &#40;Barc&#41;&#46; 2020&#59;93&#58;1&#8211;3&#46;</p>"
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        "texto" => "<p id="par1185" class="elsevierStylePara elsevierViewall">This editorial is included as a work sponsored by grants PI18&#47;000775 and AC18&#47;00072 &#40;CE&#95;ERA Net&#95;Nanomed18&#41; from Instituto de Salud Carlos III with Fondos FEDER - &#34;Una manera de hacer Europa&#34;&#46;&#46; This work is also funded by the &#34;<span class="elsevierStyleGrantSponsor" id="gs1">Fundacio bancaria la Caixa</span>&#34; &#40;<span class="elsevierStyleGrantNumber" refid="gs1">3922-19 FCRB</span>&#41;&#46;</p>"
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Article information
ISSN: 23412879
Original language: English
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