背景:随着blinatumomab在复发或难治性B细胞前体急性淋巴细胞白血病(ALL)中的使用增加,包括微小残留病(MRD)阳性病例,对其不良影响的认识逐步提高。与blinatumomab治疗相关的肺孢子虫肺炎(PCP)很少见。
方法:我们介绍了一例接受blinatumomab治疗的患者发生PCP的病例。一名70岁的女性被诊断患有费城样CRLF2过表达B细胞前体ALL,在通过先前的诱导化疗实现完全缓解后,接受了blinatumomab作为巩固治疗。在Blinatumomab输注的第二天,她出现了间歇性低烧,胸部计算机断层扫描(CT)显示细微的浸润和结节。尽管经验性甲氧苄啶-磺胺甲恶唑(TMP-SMX)预防,她进展为显著的呼吸急促和I型呼吸衰竭,乳酸脱氢酶和β-D-葡聚糖测定增加。胸部CT显示弥漫性磨玻璃影,散在小结节。干咳提示下一代外周血测序,在没有其他病原体证据的情况下,肺囊虫jirovecii检测呈阳性。因此,患者被诊断为PCP。blinatumomab的第一个周期不得不停止,并给予治疗剂量的TMP-SMX和地塞米松,在随访期间完全康复和病情稳定。
结论:PCP在接受blinatumomab治疗的B细胞前体ALL患者中很少见,但表现为早期发病和快速疾病进展。尽管有预防,在blinatumomab治疗期间不能忽视PCP感染。因此,使用blinatumomab治疗时,需要提高注意力。
BACKGROUND: 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.
METHODS: 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.
CONCLUSIONS: 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.