Hematology Unit, Department of Oncology and Hematology, Spirito Santo Hospital, Pescara, Italy.
Thoracic Surgery Unit, Spirito Santo Hospital, Pescara, Italy.
Front Immunol. 2023 Sep 28;14:1272798. doi: 10.3389/fimmu.2023.1272798. eCollection 2023.
CAR-T therapy has revolutionized the treatment of relapsed/refractory B-cell malignancies. Patients who are receiving such therapy are susceptible to an increased incidence of infections due to post-treatment immunosuppression. The need for antifungal prophylaxis during the period of neutropenia remains to be determined. The clinical outcome of a 55-year-old patient with relapsed/refractory DLBCL who received axicabtagene ciloleucel is described here. The patient developed CRS grade II and ICANS grade IV requiring tocilizumab, prolonged use of steroids and anakinra. An invasive pulmonary aspergillosis arose after 1 month from CAR-T reinfusion, resolved with tracheal sleeve pneumonectomy. The patient is now in Complete Remission. This case suggests that antifungal prophylaxis should be considered. We have now included micafungin as a standard prophylaxis in our institution.
嵌合抗原受体 T 细胞（CAR-T）疗法彻底改变了复发/难治性 B 细胞恶性肿瘤的治疗方法。接受此类治疗的患者由于治疗后的免疫抑制而容易发生感染。在中性粒细胞减少期间是否需要进行抗真菌预防仍然需要确定。本文描述了一位接受 axicabtagene ciloleucel 治疗的复发/难治性弥漫性大 B 细胞淋巴瘤（DLBCL）患者的临床结局。该患者发生了细胞因子释放综合征（CRS）Ⅱ级和免疫效应细胞相关神经毒性综合征（ICANS）Ⅳ级，需要使用托珠单抗、长期使用类固醇和 anakinra。CAR-T 回输后 1 个月发生侵袭性肺曲霉病，经气管袖状切除术解决。目前患者处于完全缓解状态。该病例提示应考虑抗真菌预防。我们现在已在我们的机构中纳入米卡芬净作为标准预防。
