古い病原体 - 新しい患者タイプ: CAR T細胞受容体の感染 もっと 複雑 な こと が あり ます か
Monica Melchio1,2, Joshua A Hill3,4, Maunank Shah5,6
1Division of Infectious Diseases, Department of Health Sciences, University of Genova, Genova, Italy.
まとめ
このケーススタディでは,COVID-19と結核を患ったリンパ腫患者の詳細が示され,CAR-T細胞治療が遅れた. 治療後,彼はアスペルギロシスを含む深刻な感染症を発症し,複雑な管理の課題を強調しました.
科学分野:
- 腫瘍学
- 感染症
- 免疫療法
背景:
- 41歳の男性で,中の拡散型大B細胞リンパ腫は,キメリック抗原受容体T細胞 (CAR- T) 治療の候補でした.
- 治療は,再発したCOVID-19と肺結核により複雑になり,遅延と抗菌剤の治療が必要になりました.
研究 の 目的:
- 複数の感染によって複雑化したリンパ腫治療の管理について説明します.
- CAR- T 治療のタイミングと,その後の感染の管理に関する課題について議論する.
- CAR- T治療後の侵入性肺アスペルギロシスの治療戦略を強調する.
主な方法:
- 患者はCAR- T治療の前に11週間の抗菌剤治療を受けた.
- CAR- Tの後,患者は侵入性肺アスペルギロシスを発症し,イサブコナゾールと抗結核療法を受けた.
- 治療には薬物相互作用と長期の治療が必要でした.
- 重度の血栓切除が原因でロベクトミーが行われました.
主要な成果:
- 結核の管理後にCAR- T療法が成功しました.
- 患者はCAR- T後のサイトカイン放出症候群と免疫効果細胞関連神経毒性症候群を発症した.
- 侵襲性肺アスペルギロシスは,イサブコナゾールと抗結核療法による8ヶ月の治療に成功しました.
- 重度の血栓切除手術が必要でした
結論:
- このケースは,同時に重症な感染を伴うCAR-T治療を受けている患者の管理の複雑さを強調しています.
- 治療のタイミング,薬物相互作用,長時間抗菌薬療法を慎重に検討することが重要です.
- 免疫不全の患者における感染症合併症の多学科的管理により,成功する結果が得られます.
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