与新型免疫治疗药物使用相关的真菌感染
Fungal Infections Associated With the Use of Novel Immunotherapeutic Agents.
作者信息
Bernardes Marilia, Hohl Tobias M
机构信息
Infectious Diseases Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, 417 E 68th, New York, NY 10065, USA.
出版信息
Curr Clin Microbiol Rep. 2020 Dec;7(4):142-149. doi: 10.1007/s40588-020-00154-4. Epub 2020 Sep 26.
Abstract
PURPOSE OF THE REVIEW
Recent concerns have emerged regarding the potential of immunotherapy to cause infection. In this review, we summarize the current literature on invasive fungal infections that occur during treatment with immune checkpoint inhibitors and chimeric antigen receptor T cell therapy.
RECENT FINDINGS
Fungal infections are uncommon with the use of checkpoint inhibitors. Most cases are caused by invasive aspergillosis and pneumocystis pneumonia and occur in patients requiring high dose corticosteroids for the management of immune-related adverse events. Conversely, fungal infections are commonly reported during therapy with CAR T cells. Most cases are caused by invasive aspergillosis and candidiasis and are likely the result of prolonged neutropenia following the conditioning regimen or immunosuppressant use for the management of cytokine release syndrome and neurotoxicity.
SUMMARY
Treatment-related toxicities that require prolonged immunosuppressive agents appear to play a key role in the development of fungal infections during immunotherapy. Ongoing surveillance is needed to fully address the risks of fungal infections with these novel agents.
摘要
综述目的
近期人们开始关注免疫疗法引发感染的可能性。在本综述中，我们总结了关于免疫检查点抑制剂和嵌合抗原受体T细胞疗法治疗期间发生的侵袭性真菌感染的当前文献。
最新发现
使用检查点抑制剂时真菌感染并不常见。大多数病例由侵袭性曲霉病和肺孢子菌肺炎引起，发生在因免疫相关不良事件管理而需要高剂量皮质类固醇的患者中。相反，CAR T细胞治疗期间真菌感染的报道很常见。大多数病例由侵袭性曲霉病和念珠菌病引起，可能是预处理方案后长期中性粒细胞减少或使用免疫抑制剂治疗细胞因子释放综合征和神经毒性的结果。
总结
需要长期使用免疫抑制剂的治疗相关毒性似乎在免疫治疗期间真菌感染的发生中起关键作用。需要持续监测以充分应对这些新型药物引发真菌感染的风险。
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