PD-1阻断免疫疗法成功挽救了异体造血干细胞移植后的播散性腺病毒感染。

IF 29.5 1区 医学 Q1 HEMATOLOGY
Fei Zhou, Feng Du, Ziyan Wang, Mengxing Xue, Depei Wu, Suning Chen, Xuefeng He
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引用次数: 0

摘要

播散性腺病毒感染是造血干细胞移植患者中死亡率较高的一种并发症。目前的治疗方案疗效低、可获得性差,这是最令人担忧的问题。程序性细胞死亡1(PD-1)阻断已被用于治疗多种慢性病毒感染。在此,我们报告了一例移植后早期播散性腺病毒感染病例。患者最初被诊断为弥漫大 B 细胞淋巴瘤,接受了 8 个周期的化疗,包括利妥昔单抗。随后,她被诊断为急性髓性白血病,并接受了单倍体移植。移植 2 个月后,她被诊断为 Epstein-Barr 病毒(EBV)阳性的移植后淋巴组织增生性疾病(PTLD),并接受了 3 次利妥昔单抗治疗。移植后 3 个月,患者被诊断为播散性腺病毒感染,上呼吸道、胃肠道和血液均受累。她首先接受了减少免疫抑制、西多福韦酯和利巴韦林治疗。然后,在常规治疗无效后,患者接受了 PD-1 抑制剂 sintilimab(200 毫克)的挽救治疗。3周后,腺病毒被清除,伴发的EB病毒也被清除。虽然患者在使用 PD-1 抑制剂后出现了肝脏移植物抗宿主病,但她在接受无类固醇治疗后痊愈了。因此,在充分权衡感染危害和副作用的前提下,PD-1 阻断免疫疗法可被视为移植后播散性腺病毒感染患者的一种可行治疗方案。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
PD-1 blockade immunotherapy as a successful rescue treatment for disseminated adenovirus infection after allogeneic hematopoietic stem cell transplantation.

Disseminated adenovirus infection is a complication with a relatively high mortality rate among patients undergoing hematopoietic stem cell transplantation. The low efficacy and poor availability of current treatment options are of major concern. Programmed cell death 1 (PD-1) blockade has been used to treat several chronic viral infections. Herein, we report a case of disseminated adenovirus infection in the early posttransplant period. The patient was diagnosed with diffuse large B-cell lymphoma at first and underwent 8 cycles of chemotherapy, including rituximab. She was subsequently diagnosed with acute myeloid leukemia and received haploidentical transplantation. She was diagnosed with Epstein‒Barr virus (EBV)-positive posttransplant lymphoproliferative disorder (PTLD) 2 months after the transplant, and 3 doses of rituximab were administered. The patient was diagnosed with disseminated adenovirus infection with upper respiratory tract, gastrointestinal tract and blood involved at 3 months after transplantation. She was first treated with a reduction in immunosuppression, cidofovir and ribavirin. Then, the patient received salvage treatment with the PD-1 inhibitor sintilimab (200 mg) after achieving no response to conventional therapy. The adenovirus was cleared 3 weeks later, and concomitant EBV was also cleared. Although the patient developed graft-versus-host disease of the liver after the administration of the PD-1 inhibitor, she was cured with steroid-free therapy. Therefore, PD-1 blockade immunotherapy can be considered a promising treatment option for patients with disseminated adenovirus infection after transplantation, with fully weighing the hazards of infection and the side effects of this therapy.

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来源期刊
CiteScore
48.10
自引率
2.10%
发文量
169
审稿时长
6-12 weeks
期刊介绍: The Journal of Hematology & Oncology, an open-access journal, publishes high-quality research covering all aspects of hematology and oncology, including reviews and research highlights on "hot topics" by leading experts. Given the close relationship and rapid evolution of hematology and oncology, the journal aims to meet the demand for a dedicated platform for publishing discoveries from both fields. It serves as an international platform for sharing laboratory and clinical findings among laboratory scientists, physician scientists, hematologists, and oncologists in an open-access format. With a rapid turnaround time from submission to publication, the journal facilitates real-time sharing of knowledge and new successes.
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