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嵌合抗原受体 T 细胞疗法治疗复发/难治性多发性骨髓瘤后巨细胞病毒视网膜炎和视网膜脱离。

Cytomegalovirus Retinitis and Retinal Detachment following Chimeric Antigen Receptor T Cell Therapy for Relapsed/Refractory Multiple Myeloma.

机构信息

Bone Marrow Transplantation Center, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China.

Institute of Hematology, Zhejiang University, Hangzhou 310058, China.

出版信息

Curr Oncol. 2022 Jan 24;29(2):490-496. doi: 10.3390/curroncol29020044.

Abstract

Cytomegalovirus (CMV) retinitis is a rare end-organ disease of CMV infection and is a marker of severe immunosuppression, especially in human immunodeficiency virus (HIV)-positive patients. In multiple myeloma (MM) patients, CMV retinitis has been reported in the post-transplant setting, with an incidence lower than 0.2%, and in patients receiving lenalidomide. Here, we describe the first case of CMV retinitis in myeloma patients following B-cell maturation antigen (BCMA)-targeted chimeric antigen receptor T (BCMA CAR-T) cell therapy. In addition to CMV, the patient developed multiple infections including a mouth ulcer, pneumonia, and fungal enteritis. While the complete remission (CR) status of MM was maintained, he regained a visual acuity of 20/1000 after appropriate ophthalmologic treatment. This single case illustrates the potential of BCMA CAR-T therapy to induce profound humoral immunosuppression, and demonstrates an imperative need for an established standard of monitoring and prophylaxis of post-CAR-T infections.

摘要

巨细胞病毒(CMV)视网膜炎是 CMV 感染的罕见终末器官疾病,是严重免疫抑制的标志物,尤其是在人类免疫缺陷病毒(HIV)阳性患者中。在多发性骨髓瘤(MM)患者中,已经在移植后环境中报告了 CMV 视网膜炎,其发病率低于 0.2%,并且在接受来那度胺治疗的患者中也有报告。在这里,我们描述了首例接受 B 细胞成熟抗原(BCMA)靶向嵌合抗原受体 T 细胞(BCMA CAR-T)细胞治疗后发生 CMV 视网膜炎的骨髓瘤患者。除 CMV 外,该患者还发生了多种感染,包括口腔溃疡、肺炎和真菌性肠炎。尽管 MM 处于完全缓解(CR)状态,但在进行适当的眼科治疗后,他的视力恢复到了 20/1000。这一例病例说明了 BCMA CAR-T 疗法可能会引起严重的体液免疫抑制,并迫切需要建立针对 CAR-T 后感染的监测和预防标准。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c758/8870699/fef9eec4f410/curroncol-29-00044-g001.jpg

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