Siriraj Medical Journal

Bispecific Protein Engager-Armed T Cells (BATs): Next-Generation Platforms for Precision Cancer Immunotherapy

Pa-thai Yenchitsomanus — 2026-05-01

Chimeric antigen receptor (CAR) T-cell therapy and CD3-directed bispecific T-cell engagers (BiTEs) have transformed cancer immunotherapy, particularly for relapsed or refractory hematologic malignancies. However, CAR T-cell therapy remains constrained by complex genetic engineering, individualized manufacturing, specialized infrastructure, high cost, limited accessibility, and treatment-related toxicities such as cytokine release syndrome (CRS) and immune effector cell-associated neurotoxicity syndrome (ICANS). In contrast, soluble BiTEs frequently require repeated dosing or continuous infusion because of their short serum half-life and may also induce CRS and neurotoxicity. To address these limitations, our research group at the Siriraj Center of Research Excellence for Cancer Immunotherapy (SiCORE-CIT) developed bispecific protein engager (BiPE)–armed T cells (BATs), a non-genetically modified and adaptable platform that combines BiPE-mediated tumor targeting with the intrinsic cytotoxic activity of activated T cells. This review positions BATs within the broader evolution of cancer immunotherapy—including monoclonal antibodies (mAbs), antibody–drug conjugates (ADCs), CAR T cells, bispecific antibodies (BsAbs), and BiTEs—and summarizes their structure and mechanism of action. BATs mediate major histocompatibility complex (MHC)-independent T-cell activation, promote immune synapse formation, and enable efficient tumor cell lysis. Clinical studies of bispecific antibody–armed T cells (BsAb-Ts), the closest clinical analogs of BATs, demonstrate feasibility, a consistent absence of dose-limiting toxicities (DLTs), and preliminary biological and clinical activity. Building on this foundation, next-generation BAT platforms targeting tumor-associated antigens and immune checkpoint molecules—including BCMA, CD138, integrin αvβ6, and PD-L1—have shown promising preclinical activity in multiple myeloma, breast cancer, and cholangiocarcinoma. Collectively, BATs represent a flexible, scalable, and potentially safer platform for next-generation precision T-cell immunotherapy.

Incidence and Associated Factors for Inappropriate Blood Cross Matching in Cardiovascular Thoracic Surgeries at a Tertiary Care Center: A Retrospective Study Using Binary Logistic Regression

Saranya Harnroongroj — 2026-04-01

Objective: To determine the incidence of inappropriate packed red cell (PRC) crossmatching in Cardiovascular Thoracic (CVT) surgeries at a service-focused tertiary care center, and to identify the associated factors for the inappropriate PRC cross-matching.

Materials and Methods: A retrospective cross-sectional study was conducted involving 640 patients who underwent CVT surgery between 2022 and 2025. The data reviewed included the patients’ demographics, operative details, and PRC utilization (specifically, crossmatching and transfusion within 24 hours postoperatively). The crossmatch to transfusion (CT) ratio, transfusion probability (%T), and transfusion index (Ti) were calculated. An individual CT ratio > 2.0 was defined as inappropriate crossmatching. Binary logistic regression was used to identify the associated factors for inappropriate PRC crossmatching, and the Youden index to determine the optimal cutoff values.

Results: Inappropriate PRC crossmatching occurred in 426 of the 640 cases (66.6%). The overall CT ratio was 2.36, exceeding the recommended threshold limit of 2.0 and suggesting excessive blood ordering. Closed heart surgeries had the highest CT ratio (13.8), followed by thoracic surgeries (4.21). Significant factors associated with inappropriate crossmatching included elective surgery, a pre-operative hematocrit level > 35.4%, and intraoperative blood loss < 275 mL.

Conclusion: Inappropriate PRC crossmatching is common in CVT surgeries, with an incidence of 66.6% in this study cohort. Elective procedures, a higher pre-operative hematocrit level, and lower intraoperative blood loss were found to be key predictors for inappropriate PRC crossmatching. These findings highlight the need for more evidence-based transfusion protocols to minimize excessive crossmatching in CVT surgeries, and optimize the utilization of blood resources.

The Outcomes of Siriraj’s Classification for Giant Inguinal Hernia: A Literature Review and Metaanalysis

Watsaphon Tangkullayanone — 2026-05-01

Objective: Giant inguinal hernia is a rare condition associated with high perioperative morbidity. Siriraj’s classification was developed to guide surgical management according to hernia extent; however, clinical outcome data remain limited. This study aimed to evaluate postoperative complications associated with giant inguinal hernia repair according to Siriraj’s classification.

Materials and Methods: A literature review and proportion meta-analysis were conducted to assess the surgical outcomes of giant inguinal hernia repair. PubMed and Google Scholar were systematically searched for studies reporting surgical management and complications of giant inguinal hernia. Studies were included if the hernia type could be classified according to Siriraj’s classification or sufficient clinical information was available. The primary outcome was postoperative complications. Pooled complication rates with 95% confidence intervals (CI) were calculated using fixed- or random-effects models based on heterogeneity.

Results: Ten studies involving 101 giant inguinal hernias were included in the meta analysis. The overall postoperative complication rate was 35% (95% CI: 0.17–0.59). Type I giant inguinal hernia showed a complication rate of 43%, while non-Type I hernias demonstrated a complication rate of 37%. Although overall complication rates were comparable, major complications were predominantly observed in cases not adhering to Siriraj’s classification. Protocol adherence was significantly associated with reduced risk of major complications (odds ratio 0.007, 95% CI: 0.0003–0.142; p=0.0013).

Conclusion: Siriraj’s classification provides a practical framework for guiding surgical management of giant inguinal hernia and may reduce major postoperative complications. Further large-scale studies are required to validate these findings.

Is Erythema Toxicum Neonatorum in Neonates Associated with Atopic Diseases?

Suthida Chaithirayanon — 2026-05-01

Objective: Erythema toxicum neonatorum (ETN) is a benign rash commonly observed in newborns, typically resolving spontaneously within one to two weeks. The lesions are characterized by multiple erythematous macules containing eosinophils and are known to be associated with peripheral eosinophilia, a condition commonly seen in atopic diseases. Therefore, the presence of ETN may be associated with the subsequent development of atopic diseases. This study aimed to determine the prevalence of atopic diseases in newborns with and without ETN and to evaluate the association between the presence of ETN and the manifestation of atopic diseases during childhood.

Materials and Methods: This retrospective cohort study utilized electronic medical records and telephone interviews of subjects born at HRH Princess Maha Chakri Sirindhorn Medical Center in 2013. Participants were divided into two groups: newborns with ETN and those without ETN. The follow-up period for diagnosing atopic diseases extended to four years after birth (2017).

Results: A total of 134 newborns were included in the study (67 with ETN and 67 without ETN). During the followup period, 12 of 67 newborns with ETN and 14 of 67 newborns without ETN developed atopic diseases. Statistical analysis revealed that the presence of ETN was not associated with an increased risk of developing atopic diseases (adjusted odds ratio (OR) 1.37; 95% CI 0.55-3.41). However, a significant association was found between a family history of atopic diseases and the development of atopic conditions in the children.

Conclusions: The presence of ETN does not increase the risk of developing atopic diseases during childhood.

Comparison of Local Versus General Anesthesia in Open Inguinal Hernioplasty: A Prospective Study on Postoperative Outcomes and Cost-Effectiveness

Chainarong Phalanusitthepha — 2026-04-01

Objective: This study evaluates whether performing open inguinal hernia repair under local anesthesia with sameday discharge is comparable to general anesthesia with inpatient admission, with respect to postoperative outcomes, recovery time, and healthcare costs.

Materials and Methods: This prospective cohort study was conducted at Siriraj Hospital and included 30 adults undergoing unilateral open inguinal hernioplasty. Patients were allocated to either local anesthesia with same-day discharge (n=15) or general anesthesia with inpatient admission (n=15). Postoperative pain, recovery time, operative efficiency, complications, and total hospital costs were assessed.

Results: Postoperative pain at rest at 8 and 24 hours was lower in the LA group compared with the GA group (1.93±1.10 vs 2.53±1.55 p=0.233, 0.87±0.83 vs 1.80±1.65 p=0.032). Patients in the LA group resumed normal activities significantly earlier, and total hospital costs were significantly lower (1.00+0.54 vs 1.40+0.51 p = 0.022, 13,453 THB vs. 41,226 THB; p<0.001). Operative time, theater time, complications, and patient demographics (age, BMI, ASA classification) were comparable between groups.

Conclusions: Open inguinal hernioplasty under local anesthesia in a day-surgery setting demonstrated clinical outcomes comparable to those of general anesthesia with inpatient admission. Additionally, this approach was associated with faster functional recovery and significantly reduced hospital costs. Local anesthesia represents a safe, efficient, and cost-effective alternative for appropriately selected patients.