[Immunotherapy with CAR-T cells in paediatric haematology-oncology]

Despite being a rare disease, cancer is the first cause of mortality due to disease during the paediatric age in the developed countries. The current, great increase in new treatments, such as immunotherapy, constitutes a new clinical and regulatory paradigm. Cellular immunotherapy is one of these types of immunotherapy. In particular, the advanced therapy drugs with chimeric antigen receptors in the T-lymphocytes (CAR-T), and particularly the CAR-T19 cells, has opened up a new scenario in the approach to haematology tumours like acute lymphoblastic leukaemia and the B-Cell lymphomas. The approval of tisagenlecleucel and axicabtagene ciloleucel by the regulatory authorities has led to the setting up of the National Plan for Advanced Therapies-CAR-T drugs in Spain. There is evidence of, not only the advantage of identifying the centres most suitable for their administration, but also the need for these to undergo a profound change in order that their healthcare activity is extended, in some cases, to the ability for the in-house manufacture of these types of therapies. The hospitals specialised in paediatric haematology-oncology thus have the challenge of progressing towards a healthcare model that integrates cellular immunotherapy, having the appropriate capacity to manage all aspects relative to their use, manufacture, and administration of these new treatments.

Adoptive immunotherapy with antiviral T cells: Methods and results

Viral infections and reactivations are one of the main causes of morbidity and mortality in patients who undergo allogeneic haematopoietic progenitor cell transplantation. Adoptive immunotherapy with virus-specific Tcells (from donor to patient) has shown efficacy in the antiviral treatment of patients who have undergone transplantation and whose immune system has not yet been reconstituted. Currently, and according to the requirements of the corresponding agencies that regulate the production of these advanced personalised therapies, the production and application of these cell products are being optimised in such a way that they comply with good manufacturing practice standards and are safe and effective for treating patients. To facilitate their implementation, we need to understand the foundations of producing and using virus-specific Tcells. This study reviews the evolution of the methodology for producing antiviral Tcells and the studies that support their therapeutic efficacy. The study covers up to the current production platforms, whose commercialisation has begun in Spain. These platforms will help obtain virus-specific Tcells and chimeric antigen receptor Tcells, among others, in a completely automated manner and under good manufacturing practice conditions. The implementation of these new methodologies in the Spanish healthcare system will undoubtedly facilitate patients' access to a new repertoire of advanced therapies.

Clinical application of cell, gene and tissue therapies in Spain

Scientific and technical advances in the areas of biomedicine and regenerative medicine have enabled the development of new treatments known as "advanced therapies", which encompass cell therapy, genetics and tissue engineering. The biologic products that can be manufactured from these elements are classified from the standpoint of the Spanish Agency of Medication and Health Products in advanced drug therapies, blood products and transplants. This review seeks to provide scientific and administrative information for clinicians on the use of these biologic resources.

Innovative therapeutic strategies for recessive dystrophic epidermolysis bullosa

Recessive dystrophic epidermolysis bullosa (RDEB) is among the most serious rare skin diseases. It is also the rare skin disease for which most effort has been expended in developing advanced therapeutic interventions. RDEB is caused by collagen VII deficiency resulting from COL7A1 mutations. Therapeutic approaches seek to replenish collagen VII and thus restore dermal-epidermal adhesion. Therapeutic options under development include protein therapy and different cell-based and gene-based therapies. In addition to treating skin defects, some of these therapies may also target internal mucosa. In the coming years, these novel therapeutic approaches should substantially improve the quality of life of patients with RDEB.