PDF(Pubmed)
Abstract：
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.
摘要：
CAR-T疗法彻底改变了复发性/难治性B细胞恶性肿瘤的治疗。正在接受这种治疗的患者由于治疗后的免疫抑制而易于感染的发生率增加。在中性粒细胞减少症期间对抗真菌预防的需求仍有待确定。此处描述了接受axicabtageneciloleucel的55岁复发/难治性DLBCL患者的临床结果。患者出现CRSII级和ICANSIV级，需要托珠单抗，长期使用类固醇和anakinra。CAR-T回输1个月后出现侵袭性肺曲霉病，用气管套管全肺切除术解决。患者目前处于完全缓解期。这种情况表明应考虑抗真菌预防。我们现在已经将米卡芬净作为我们机构的标准预防措施。
