Department of Pharmacy, Kanazawa Medical University Hospital, 1-1 Daigaku, Uchinada, Kahoku 920-0293, Japan.
Medical Research Institute, Kanazawa Medical University, 1-1 Daigaku, Uchinada, Kahoku 920-0293, Japan.
Medicina (Kaunas). 2022 May 29;58(6):733. doi: 10.3390/medicina58060733.
Recent advances in chemotherapy have led to the emergence of new types of anticancer agents. With these advances, cases of side effects that have not been witnessed in the past have emerged. The systems of side effect evaluation and their grading have been based on the existing knowledge, such as the CTCAE (Common Terminology Standard for Adverse Events) for evaluating adverse drug reactions in cancer chemotherapy clinical trials. Therefore, new types of side effects may be overlooked or underestimated. Blinatumomab is a bispecific T-cell-engager (BiTE) antibody with specificity for CD19 on B cells and CD3 on T cells. Neurological events, such as neuropathy and encephalopathy, are serious side effects of BiTE antibodies. We encountered a case of a 62-year-old woman who experienced short-term memory impairment and dysgraphia after the first blinatumomab administration for Philadelphia chromosome negative (Ph-) B-cell acute lymphoblastic leukemia (ALL). The CTCAE does not include dysgraphia as a classifier for antibody therapies, such as blinatumomab, and immune effector cell-associated neurotoxicity syndrome, which is defined as a Chimeric antigen receptor T cell therapy-related toxicity; dysgraphia is included in the list of symptoms but is not graded. In this case, the severity of dysgraphia differed depending on the complexity of the letters examined. There is no report that the severity of dysgraphia depends on the letters' complexity, and therefore, it may be overlooked when using simple letters. We have reported the characteristics of dysgraphia in this case and the differences observed when judging different letters.
近年来,化疗领域的进展催生了新型抗癌药物。随着这些进展,过去未曾出现过的副作用病例也逐渐浮现。副作用的评估和分级系统一直基于现有知识,例如癌症化疗临床试验中评估药物不良反应的 CTCAE(常见不良事件术语标准)。因此,新型副作用可能会被忽视或低估。blinatumomab 是一种双特异性 T 细胞衔接(BiTE)抗体,对 B 细胞上的 CD19 和 T 细胞上的 CD3 具有特异性。神经病变和脑病等神经事件是 BiTE 抗体的严重副作用。我们遇到了一例 62 岁女性,她在接受费城染色体阴性(Ph-)B 细胞急性淋巴细胞白血病(ALL)的第一剂blinatumomab 治疗后出现短期记忆障碍和书写障碍。CTCAE 并未将书写障碍纳入blinatumomab 等抗体疗法的分类器中,也未将免疫效应细胞相关神经毒性综合征(immune effector cell-associated neurotoxicity syndrome)纳入嵌合抗原受体 T 细胞治疗相关毒性的分类器中;虽然将书写障碍列入症状清单,但未对其进行分级。在这种情况下,书写障碍的严重程度取决于所检查字母的复杂程度。目前尚无报告表明书写障碍的严重程度取决于字母的复杂程度,因此,在使用简单字母时可能会被忽视。我们报告了该病例中书写障碍的特征以及在判断不同字母时观察到的差异。