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新型骨髓瘤治疗期间的感染

Infections during novel myeloma therapies.

作者信息

Liu Alice J, Slavin Monica A, Harrison Simon J, Teh Benjamin W

机构信息

Department of Infectious Diseases, Peter MacCallum Cancer Centre, Parkville, Australia.

National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, Melbourne, Australia.

出版信息

Leuk Lymphoma. 2025 Mar;66(3):420-432. doi: 10.1080/10428194.2024.2428819. Epub 2024 Nov 18.

Abstract

New generation therapies such as bispecific antibodies (BsAb), chimeric antigen receptor T-cell therapy (CAR T) and antibody-drug conjugates (ADC) have revolutionized the treatment of relapsed/refractory multiple myeloma (RRMM). However, there is emerging evidence of increased infection risk associated with these treatments in clinical trials and observational settings. This infection risk may be mediated by on-target, off-tumor side effects such as cytokine release syndrome, hypogammaglobulinaemia and cytopenias, disease-related humoral impairment and the consequences of multiple previous lines of treatment. While bacterial and viral pathogens predominate, reactivation of latent infection and opportunistic infections also warrant attention. This review characterizes the epidemiology of infections associated with novel therapies for RRMM to guide prophylaxis and antimicrobial prescribing in this patient population and highlights future areas of focus to inform ongoing infection prevention strategies.

摘要

双特异性抗体(BsAb)、嵌合抗原受体T细胞疗法(CAR T)和抗体药物偶联物(ADC)等新一代疗法彻底改变了复发/难治性多发性骨髓瘤(RRMM)的治疗方式。然而,在临床试验和观察性研究中,越来越多的证据表明这些治疗会增加感染风险。这种感染风险可能由靶点相关的肿瘤外副作用介导,如细胞因子释放综合征、低丙种球蛋白血症和血细胞减少、疾病相关的体液免疫损害以及多线既往治疗的后果。虽然细菌和病毒病原体占主导地位,但潜伏感染的重新激活和机会性感染也值得关注。本综述描述了与RRMM新型疗法相关感染的流行病学特征,以指导该患者群体的预防和抗菌药物处方,并强调未来的重点领域,为正在进行的感染预防策略提供参考。

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