一名曾患弥漫性大 B 细胞淋巴瘤的患者在接受 CAR-T 疗法后出现长期 COVID-19 肺炎和严重肺损伤:强调皮质类固醇的作用。

Mark Ehioghae, Harini Shah, Anu Taylor, Brian Buggy, Gabriel Mikhael
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引用次数: 0

摘要

导言:COVID-19可对免疫力低下的患者(包括血液恶性肿瘤患者)造成严重后果。在接受嵌合抗原受体T细胞(CAR-T)治疗的弥漫大B细胞淋巴瘤(DLBCL)患者中,引起肺炎和肺损伤的长期感染并不多见:一名 43 岁的男性患者有 DLBCL 病史,接受 CAR-T 治疗后病情缓解了 2 年,但出现了持续的 COVID 感染,聚合酶链反应阳性证实了这一点。这种感染慢慢发展为有症状的低氧性肺炎和活检证实的弥漫性肺泡损伤,对皮质类固醇治疗有反应:讨论:COVID-19 给有血液系统恶性肿瘤病史的患者带来了更大的风险,可导致严重的呼吸困难和死亡。研究表明,长时间的肺炎可能需要皮质类固醇来改善。然而,目前还缺乏有关治疗COVID-19长期肺炎的适当方案的数据:本病例凸显了治疗血液恶性肿瘤免疫功能低下患者 COVID-19 感染所面临的挑战。皮质类固醇治疗效果显著,但剂量和持续时间应根据患者的个体反应而定。长期监测、个体化治疗计划和研究对于优化这一易感人群的治疗效果至关重要。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Prolonged COVID-19 Pneumonitis and Severe Lung Injury in a Patient with a History of Diffuse Large B-cell Lymphoma after CAR-T Therapy: Highlighting the Role of Corticosteroids.

Introduction: COVID-19 can have severe consequences for immunocompromised individuals, including those with hematological malignancies. Prolonged infections causing pneumonia and lung injury are rare in patients with diffuse large B-cell lymphoma (DLBCL) treated with chimeric antigen receptor T-cell (CAR-T).

Case presentation: A 43-year-old male with a history of DLBCL, in remission for 2 years after CAR-T therapy, developed a persistent COVID infection, as confirmed via positive polymerase chain reaction. This slowly progressed to symptomatic hypoxemic pneumonitis and biopsy-proven diffuse alveolar damage, which responded to corticosteroid treatment.

Discussion: COVID-19 poses increased risks to patients with a history of hematologic malignancies and can lead to severe respiratory distress and mortality. Studies have shown prolonged pneumonitis may require corticosteroids for improvement. However, data on appropriate regimen for managing prolonged COVID-19 pneumonitis are lacking.

Conclusions: This case highlights challenges of the treatment of COVID-19 infections in immunocompromised individuals with hematological malignancies. Corticosteroid treatment shows benefits, but dosing and duration should be based on individual patient response. Extended monitoring, individualized treatment plans, and research are crucial for optimizing outcomes in this vulnerable population.

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