管理副作用:在多发性骨髓瘤中使用免疫疗法的指南
Emily C Liang1, Surbhi Sidana2
1University of Washington and Fred Hutchinson Cancer Center, Seattle, WA.
多发性骨髓瘤的新型免疫疗法,如CAR T细胞疗法,提供了新的希望,但导致严重的毒性,如细胞因子释放综合征 (CRS) 和神经毒性. 管理策略正在发展,但对延迟神经毒性和HLH类综合征的有效治疗仍然是一个挑战.
科学领域:
- 在瘤学瘤学.
- 免疫学 免疫学 免疫学
- 血液学 血液学 血液学
背景情况:
- 化学抗原受体 (CAR) T细胞疗法和双特异性T细胞招募抗体代表了治疗复发性/耐药性多发性髓瘤的重大进展.
- B细胞成熟抗原 (BCMA) 是主要目标,其他目标正在调查中.
研究的目的:
- 审查与多发性骨髓瘤新型免疫疗法相关的毒性.
- 为这些新出现的治疗相关不良事件提供管理建议.
主要方法:
- 审查当前的文献和共识建议.
- 毒性分析包括细胞因子释放综合征 (CRS),免疫效应细胞相关的神经毒性综合征 (ICANS),细胞衰竭,感染,延迟的神经毒性,以及免疫效应细胞相关的血细胞性淋巴组织细胞化 (HLH) 类综合征 (IEC-HS).
主要成果:
- 已经确立的CRS (托西利祖马布,类固醇) 和ICANS (类固醇,阿纳金拉) 的治疗方法存在.
- 细胞衰竭和感染的管理遵循血造细胞移植后的原则.
- 目前对延迟神经毒性和IEC-HS的有效治疗方法有限,尽管使用类固醇和anakinra.
结论:
- 了解这些毒性的病理生理学和危险因素需要进一步的研究.
- 跨学科的合作对于管理复杂的毒性至关重要.
- 广泛的差异诊断方法对于最佳的患者护理至关重要.
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