Bone Marrow Transplantation Center, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China.
Institute of Hematology, Zhejiang University, Hangzhou 310058, China.
Curr Oncol. 2022 Jan 24;29(2):490-496. doi: 10.3390/curroncol29020044.
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.
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。