Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, UOC Ematologia Geriatrica ed Emopatie rare, Università Cattolica del Sacro Cuore, Rome, Italy.
Fondazione Policlinico Universitario Agostino Gemelli - IRCCS, Rome, Italy.
Clin Exp Med. 2023 Oct;23(6):1823-1833. doi: 10.1007/s10238-023-01000-9. Epub 2023 Jan 30.
Infections represent one of the most frequent complications during the treatment of patients with Acute Lymphoblastic Leukemia (ALL): of these, almost half develop an infectious event in the majority of cases in induction. The new monoclonal and bispecific antibodies and CAR-T, besides offering new perspectives in the overall survival and disease-free survival of patients, may also transform the epidemiology of infections in ALL by improving the toxicity of treatments. In this review, we examined studies published in the literature over the past 12 years and described the infectious complications of therapy with Blinatumomab, Inotuzumab, Rituximab and CAR-T in adult and pediatric patients with ALL. Infections are less frequent than in traditional chemotherapy treatment with vincristine, corticosteroids and anthracyclines, which has been the backbone of therapy for patients with ALL for years. On the other hand, the infection scenario in the CAR-T setting is quite peculiar: In these patients, infections are more frequent in the first month after infusion and are predominantly bacterial. As the time moves away from day zero, viral infections become more frequent, occurring mainly in patients who have had prolonged cytopenia and major cytokine release syndrome.
感染是急性淋巴细胞白血病（ALL）患者治疗过程中最常见的并发症之一：其中近一半的患者在诱导期发生感染事件。新型单克隆抗体和双特异性抗体以及 CAR-T 除了在患者的总生存率和无病生存率方面提供新的前景外，还可以通过改善治疗毒性来改变 ALL 中的感染流行病学。在这篇综述中，我们研究了过去 12 年中发表的文献中的研究，并描述了 Blinatumomab、Inotuzumab、Rituximab 和 CAR-T 在成人和儿科 ALL 患者中的治疗相关感染并发症。与多年来一直是 ALL 患者治疗基础的长春新碱、皮质类固醇和蒽环类药物的传统化疗相比，感染的发生频率较低。另一方面，CAR-T 治疗中的感染情况相当特殊：在这些患者中，输注后第一个月感染更为频繁，主要是细菌感染。随着时间远离零天，病毒感染变得更加频繁，主要发生在经历长时间细胞减少和细胞因子释放综合征的患者中。
