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Brentuximab治疗霍奇金淋巴瘤合并自身免疫性疾病患者的并发症——病例系列

Complications of Brentuximab Therapy in Patients with Hodgkin's Lymphoma and Concurrent Autoimmune Pathology-A Case Series.

作者信息

Preda Oana Diana, Bădeliță Sorina, Ursuleac Iulia, Irimia Ruxandra Maria, Balanica Sonia, Cojocaru Monica, Cotruta Cristina, Dobrea Camelia, Coriu Daniel

机构信息

University of Medicine and Pharmacy "Carol Davila", 050474 Bucharest, Romania.

Fundeni Clinical Institute, 022328 Bucharest, Romania.

出版信息

Hematol Rep. 2024 May 20;16(2):299-307. doi: 10.3390/hematolrep16020030.

Abstract

: Brentuximab Vedotin (BV) has revolutionized the treatment landscape for Hodgkin's lymphoma, yet its effects on pre-existing autoimmune disorders remain elusive. : Here, we present four cases of patients with concurrent autoimmune conditions-Crohn's disease, vitiligo, type I diabetes, and minimal change disease-undergoing BV therapy for Hodgkin's lymphoma. The patients were treated with A-AVD instead of ABVD due to advanced-stage disease with high IPI scores. Our findings reveal the surprising and complex interplay between BV exposure and autoimmune manifestations, highlighting the need for multidisciplinary collaboration in patient management. Notably, the exacerbation of autoimmune symptoms was observed in the first three cases where T-cell-mediated autoimmunity predominated. Additionally, BV exposure precipitated autoimmune thrombocytopenia in the vitiligo patient, underscoring the profound disruptions in immune regulation. Conversely, in the minimal change disease case, a disease characterized by a blend of B- and T-cell-mediated immunity, the outcome was favorable. : This paper underscores the critical importance of vigilance toward autoimmune flare-ups induced by BV in patients with concurrent autoimmune conditions, offering insights for tailored patient care.

摘要

本妥昔单抗(BV)彻底改变了霍奇金淋巴瘤的治疗格局,但其对既往存在的自身免疫性疾病的影响仍不明确。在此,我们报告4例同时患有自身免疫性疾病(克罗恩病、白癜风、I型糖尿病和微小病变病)且正在接受BV治疗的霍奇金淋巴瘤患者。由于疾病分期较晚且国际预后指数(IPI)评分较高,这些患者接受了A-AVD方案而非ABVD方案治疗。我们的研究结果揭示了BV暴露与自身免疫表现之间令人惊讶且复杂的相互作用,凸显了患者管理中多学科协作的必要性。值得注意的是,在前3例以T细胞介导的自身免疫为主的病例中,观察到自身免疫症状加重。此外,BV暴露导致白癜风患者出现自身免疫性血小板减少症,强调了免疫调节的严重紊乱。相反,在微小病变病病例中,该病以B细胞和T细胞介导的免疫混合为特征,结果良好。本文强调了对合并自身免疫性疾病患者中BV诱导的自身免疫发作保持警惕的至关重要性,为个性化患者护理提供了见解。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d9f5/11130784/84c5bcb8314e/hematolrep-16-00030-g001.jpg

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