In our Support Group Leader team discussion, the subject of T-Cells came up, naturally, with the many abstracts focusing on Chimeric Antigen Receptor-T Cell (CAR-T) therapy at the 62nd Annual American Society (ASH) meeting. What was appreciated is that there are many types of T-Cells, and people wanting to know more about their function.
To understand T-Cells, we need to step back to the white blood cell (WBC). There are 5 subcomponents of the WBC (neutrophil, lymphocyte, macrophage, basophil and eosinophil). Neutrophils may be familiar to some, especially if you have been through stem cell transplant, as the absolute neutrophil count (ANC) is a determinant of when people have reached engraftment post-transplant.
You may be surprised that you have some familiarity with lymphocytes, other than in reference to CAR-T therapy. Lymphocytes have 2 subsets, B-cells and T-Cells. B-cells, once fully matured and differentiated, become plasma cells, an important part of the immune system, but also the foundation of multiple myeloma.
- T-lymphocytes differentiate into a variety of subtypes: T-helper, regulatory (Treg), and memory cells.
- Helper T-Cells (HTC), also known as CD4+ cells, activate the other T&B cells when an immune response is needed toward an “antigen”, a foreign substance.
- Regulatory (Treg), also known as cytotoxic T-cells and include NKT-cells, are activated by various cytokines, and bind to and kill cells like cancer and infections.
- Memory cells, just as they are named, remember the antigen
T&B cells work together. Helper-T cells, when alerted by a macrophage, recognize a foreign substance which activates the release of different cytokines. The cytokines trigger B-cells to create antibodies (humoral response), and cytotoxic T-cells to destroy the target (cellular response).
Understanding this complex system can be challenging. With my Italian descent, I will try to explain this in terms of The Mob.
The Mob Story
“Mac(rophage) says to the (anti)Gen(t), ‘Hey, I don’t know you! You don’t belong here. I’m calling in some Help to take you to The Boss (T&B-cells).” The Help, HTC, latches on to the Gent, and activates The Boss. The Boss says, ‘Yo’, T-Reg, we gotta problem here. Take him out.” In a dark alley, the T-Reg and his NKt Gang take out the Gent. But if he or his kind ever shows up again, they will remember him (memory cells), and call in their Anti-body friends to take him out. “
This may be silly, but I hope it helps you remember the key players in this part of the immune function.
There are some nice images of the cell lines come from National Institute of Health (NIH) (https://stemcells.nih.gov/info/2001report/chapter5.htm).
Visit Encyclopedia Britannica, Online Encyclopedia at this link to see another good visual representation of cell lines at https://www.britannica.com/science/lymphocyte/images-videos.
There is so much complexity to the immune system. This just barely scrapes the surface. As more and more therapies use the immune system as a way to treat myeloma, having a basic understanding of the immune system can be helpful.
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Support group leaders:
| Jack Aiello | @JackMAiello | Support Group Leader, SF Bay |
| Sheri Baker | @blondie1746 | Support Group Leader, Boise, ID |
| Yelak Biru | NorthTxMSG | Support Group Leader, NW Arkansas |
| Cindy Chmielewski | @MyelomaTeacher | Support Group Leader, Philadelphia |
| John DeFlice | @JohnDe1MYELOMA | Support Group Leader, Sante Fe, NM |
| Linda Huguelet | @LindaMYELOMA | Support Group Leader, Chattanooga, TN |
| Teresa Miceli | @IMFnurseMYELOMA | Support Group Leader, Rochester, MN |
| Jim Omel | @IMFjimMYELOMA | Support Group Leader, Grand Island, NE |
| Valarie Traynham | @MyelomaValarie | Support Group Leader, Aurora, IL |
| Michael Tuohy | @IMFmikeMyeloma | Support Group Leader, Prospect, CT |
| Robin Tuohy | @IMFSupport | IMF Vice President, Support Groups |
| Tiffany Williams | @MyelomaHope | Support Group Leader, Charleston & Orangeburg, SC |
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Blogs: http://ash2020blogs.myeloma.org/
And you can find me on Twitter at @IMFnurseMYELOMA
Teresa Miceli, RN BSN OCN
SGL and Nurse Liaison