Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania.
Memorial Sloan Kettering Cancer Center, New York, New York.
Clin Cancer Res. 2020 Jul 15;26(14):3514-3516. doi: 10.1158/1078-0432.CCR-20-1427. Epub 2020 Apr 28.
As the SARS-CoV-2 (COVID-19) pandemic spreads and the number of Bruton's tyrosine kinase inhibitor (BTKi)-treated COVID-19-affected patients grows, we must consider the pros and cons of BTKi discontinuation for our patients. In favor of BTKi continuation, BTK plays an active role in macrophage polarization. By modulating key transcription factors, BTK may regulate macrophage polarization downstream of classic M1 and M2 polarizing stimuli and mitigate the hyperinflammatory state associated with COVID-19. In favor of BTKi discontinuation, we note a potentially increased risk of secondary infections and impaired humoral immunity. We hypothesize that the potential benefit of blunting a hyperinflammatory response to SARS-CoV-2 through attenuation of M1 polarization outweighs the potential risk of impaired humoral immunity, not to mention the risk of rapid progression of B-cell malignancy following BTKi interruption. On the basis of this, we suggest continuing BTKi in patients with COVID-19.
随着 SARS-CoV-2（COVID-19）大流行的传播和接受布鲁顿酪氨酸激酶抑制剂（BTKi）治疗的 COVID-19 患者数量的增加，我们必须考虑为我们的患者继续或停止 BTKi 治疗的利弊。支持继续 BTKi 治疗的观点认为，BTK 在巨噬细胞极化中发挥积极作用。BTK 通过调节关键转录因子，可能在经典 M1 和 M2 极化刺激物的下游调节巨噬细胞极化，并减轻与 COVID-19 相关的过度炎症状态。支持停止 BTKi 治疗的观点则认为，这可能会增加继发感染和体液免疫受损的风险。我们假设，通过抑制 M1 极化来减轻对 SARS-CoV-2 的过度炎症反应的潜在益处超过了体液免疫受损的潜在风险，更不用说 BTKi 中断后 B 细胞恶性肿瘤快速进展的风险了。基于这一点，我们建议 COVID-19 患者继续使用 BTKi。
