伊鲁替尼治疗后的中枢侵入性曲霉病

Kurian Matthew, Vick Eric, Khanapara Dipen
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引用次数: 0

摘要

伊鲁替尼是布鲁顿的酪氨酸激酶抑制剂,现在已成为治疗慢性淋巴细胞白血病和其他淋巴细胞癌的标准治疗药物。随着其使用的增加,肿瘤学家必须更加了解其潜在的副作用。伊鲁替尼通常被认为比标准免疫疗法具有更小的免疫抑制作用;然而,仍然会造成毁灭性的副作用。我们提出了一例中枢神经系统侵袭性曲霉病患者与瓦尔登斯特罗姆的大球蛋白血症正在伊鲁替尼管理。我们假设伊鲁替尼治疗可能与x - γ球蛋白血症相似,从而使我们的患者处于发生这种侵袭性真菌感染的风险中。cns侵袭性曲霉病的传统危险因素包括中性粒细胞减少、全身糖皮质激素治疗、乳突切除术、脊髓麻醉和棘旁糖皮质激素注射。肿瘤学家需要权衡伊鲁替尼治疗在特定人群中的风险和益处,未来可能会有更多的数据表明,在使用伊鲁替尼的同时,可能会增加经验性抗真菌覆盖。
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CNS-invasive aspergillosis following ibrutinib therapy
Ibrutinib is Bruton’s tyrosine kinase inhibitor that now become the standard of care for the treatment of CLL (chronic lymphocytic leukemia) and other lymphoid cancers. With its increasing usage, oncologists must become more aware of their potential side effect profile. Ibrutinib is typically thought to be less immunosuppressive than standard immunotherapy; however, can still cause devastating side effects. We present a case of CNS-invasive aspergillosis in a patient with Waldenstrom’s macroglobulinemia being managed with ibrutinib. We hypothesize that treatment with ibrutinib can resemble those with X-gammaglobulinemia, thus putting our patient at risk of developing such an invasive fungal infection. Traditional risk factors for CNS-invasive aspergillosis include neutropenia, systemic glucocorticoid treatment, mastoidectomy, spinal anesthesia and paraspinal glucocorticoid injections. Oncologists need to weigh the risks and benefits of ibrutinib therapy in certain populations and more data in the future may suggest potentially adding empiric antifungal coverage with its usage.
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