Department of Pediatrics, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, South Korea.
Department of Radiology, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, South Korea.
J Oncol Pharm Pract. 2021 Dec;27(8):2045-2048. doi: 10.1177/10781552211015776. Epub 2021 May 30.
Pneumatosis intestinalis is characterized by air in the subserosal or submucosal layer of the intestine, with the severity ranging from mild and asymptomatic to symptomatic with serious conditions such as intestinal ischemia and perforation requiring surgery. Although several etiologies, including those from conventional chemotherapy agents and molecular target agents, have been suggested, blinatumomab-related pneumatosis intestinalis is quite rare.
An 11-year-old girl with history of B-cell ALL presented with bone marrow relapse 3 years after completion of initial chemotherapy. Reinduction chemotherapy and blinatumomab as post-reinduction consolidation were initiated. On day 28 of blinatumomab therapy, pneumatosis intestinalis from the ascending colon to the hepatic flexure was found incidentally on abdominal computed tomography.Management and outcome: After withholding blinatumomab therapy for 1 month, pneumatosis intestinalis improved significantly without abnormal gastrointestinal symptoms. Blinatumomab was resumed and safely completed. The computed tomography performed 4 months later showed complete resolution of pneumatosis intestinalis. The patient has been in good condition for over 1 year to date.
To our knowledge, this is the first case report of pneumatosis intestinalis after blinatumomab therapy in a pediatric patient with relapsed precursor B-cell acute lymphoblastic leukemia. Herein, we highlight the importance of early detection of pneumatosis intestinalis through imaging follow-up during blinatumomab therapy.
肠气肿的特征是肠的浆膜下或黏膜下层有空气，严重程度从轻度无症状到伴有严重情况，如肠缺血和穿孔需要手术的症状不等。尽管已经提出了几种病因，包括来自常规化疗药物和分子靶向药物的病因，但与blinatumomab 相关的肠气肿非常罕见。
一名 11 岁女孩，在完成初始化疗 3 年后出现 B 细胞 ALL 骨髓复发。开始进行再诱导化疗和blinatumomab 作为再诱导后的巩固治疗。在blinatumomab 治疗的第 28 天，腹部计算机断层扫描偶然发现从升结肠到肝曲的肠气肿。
在停用blinatumomab 治疗 1 个月后，肠气肿显著改善，没有胃肠道异常症状。重新开始并安全完成blinatumomab 治疗。4 个月后进行的计算机断层扫描显示肠气肿完全消退。迄今为止，患者状况良好，已超过 1 年。
据我们所知，这是首例复发前体 B 细胞急性淋巴细胞白血病儿童患者在接受blinatumomab 治疗后发生肠气肿的病例报告。在此，我们强调了在blinatumomab 治疗期间通过影像学随访早期发现肠气肿的重要性。
