Division of General Internal Medicine, Department of Primary Care and Family Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, State Key Laboratory of Complex Severe and Rare Diseases, Beijing, China.
Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Chemotherapy. 2024;69(2):104-107. doi: 10.1159/000538256. Epub 2024 Mar 20.
With the increasing use of blinatumomab in relapsed or refractory B-cell precursor acute lymphoblastic leukemia (ALL), including minimal residual disease (MRD)-positive cases, awareness of its adverse effects has gradually improved. Pneumocystis jirovecii pneumonia (PCP) associated with blinatumomab therapy is rare.
We present a case of PCP in a patient undergoing blinatumomab therapy. A 70-year-old female diagnosed with Philadelphia-like CRLF2 overexpression B-cell precursor ALL received blinatumomab as consolidation therapy after achieving complete remission with prior induction chemotherapy. On the second day of blinatumomab infusion, she developed intermittent low-grade fever, and chest computed tomography (CT) revealed subtle infiltrates and nodules. Despite empiric trimethoprim-sulfamethoxazole (TMP-SMX) prophylaxis, she progressed to significant shortness of breath and type I respiratory failure, with increased lactate dehydrogenase and β-D-glucan assays. Chest CT showed diffuse ground-glass opacities with scattered small nodules. The dry cough prompted next-generation sequencing of peripheral blood, which tested positive for pneumocystis jirovecii without evidence of other pathogens. Consequently, the patient was diagnosed with PCP. The first cycle of blinatumomab had to be discontinued, and therapeutic dosages of TMP-SMX and dexamethasone were administered, resulting in full recovery and stable condition during follow-ups.
PCP is rare in B-cell precursor ALL patients receiving blinatumomab therapy but manifests with early onset and rapid disease progression. Despite prophylaxis, PCP infection cannot be ignored during blinatumomab therapy. Therefore, heightened attention is warranted when using blinatumomab therapy.
随着blinatumomab 在复发性或难治性 B 细胞前体急性淋巴细胞白血病（ALL）中的应用增加，包括微小残留病（MRD）阳性病例，其不良反应的认识逐渐提高。与blinatumomab 治疗相关的卡氏肺孢子虫肺炎（PCP）较为罕见。
我们报告一例接受blinatumomab 治疗的患者发生 PCP。一名 70 岁女性，诊断为费城样 CRLF2 过表达 B 细胞前体 ALL，在接受诱导化疗达到完全缓解后，接受 blinatumomab 作为巩固治疗。在blinatumomab 输注的第二天，她出现间歇性低热，胸部计算机断层扫描（CT）显示细微浸润和结节。尽管进行了经验性复方磺胺甲噁唑（TMP-SMX）预防，但她的病情进展为明显的呼吸急促和 I 型呼吸衰竭，乳酸脱氢酶和β-D-葡聚糖检测增加。胸部 CT 显示弥漫性磨玻璃影伴散在小结节。干咳促使对周围血进行下一代测序，结果显示卡氏肺孢子虫阳性，无其他病原体证据。因此，患者被诊断为 PCP。必须停止第一个周期的 blinatumomab，并给予 TMP-SMX 和地塞米松的治疗剂量，随访期间完全恢复并稳定。
PCP 在接受blinatumomab 治疗的 B 细胞前体 ALL 患者中较为罕见，但发病早且疾病进展迅速。尽管进行了预防，但在blinatumomab 治疗期间不能忽视 PCP 感染。因此，在使用 blinatumomab 治疗时需要高度警惕。
