2例急性B淋巴细胞白血病合并侵袭性真菌病儿童应用贝林妥欧单抗桥接治疗分析

Blinatumomab as bridging therapy in two children with B-cell acute lymphoblastic leukemia complicated by invasive fungal disease

摘要:

该文报道2例接受贝林妥欧单抗桥接治疗的急性B淋巴细胞白血病（B-cell acute lymphoblastic leukemia, B-ALL）合并侵袭性真菌病（invasive fungal disease, IFD）患儿。病例1为4个月女婴，化疗期间反复高热伴肢体肌力下降，血培养及外周血、支气管肺泡灌洗液、脑脊液二代测序（next-generation sequencing, NGS）均阴性，但胸部CT和头颅MRI可见明显感染灶。病例2为2岁男性患儿，化疗期间反复高热伴多部位炎性包块，外周血及包块脓液NGS均检出热带念珠菌，血培养及影像学检查未见明显异常。2例患儿经抗真菌和贝林妥欧单抗治疗后症状、体征及影像学表现明显好转，并且B-ALL处于持续缓解状态。该报道表明，B-ALL合并IFD患儿接受贝林妥欧单抗桥接治疗可在免疫抑制合并严重真菌感染时重建免疫系统并控制原发病。

Abstract:

This article reports two cases of children with B-cell acute lymphoblastic leukemia (B-ALL) complicated by invasive fungal disease (IFD) who received bridging treatment using blinatumomab. Case 1 was a 4-month-old female infant who experienced recurrent high fever and limb weakness during chemotherapy. Blood culture was negative, and next-generation sequencing (NGS) of peripheral blood, bronchoalveolar lavage fluid, and cerebrospinal fluid were all negative. Chest CT and cranial MRI revealed obvious infection foci. Case 2 was a 2-year-old male patient who experienced recurrent high fever with multiple inflammatory masses during chemotherapy. Candida tropicalis was detected in peripheral blood and abscess fluid using NGS, while blood culture and imaging examinations showed no obvious abnormalities. After antifungal and blinatumomab therapy, both cases showed significant improvement in symptoms, signs, and imaging, and B-ALL remained in continuous remission. The report indicates that bridging treatment with blinatumomab in children with B-ALL complicated by IFD can rebuild the immune system and control the underlying disease in the presence of immunosuppression and severe fungal infection.