Severe cytomegalovirus enterocolitis developing following daratumumab exposure in three patients with multiple myeloma
Severe cytomegalovirus enterocolitis developing following daratumumab exposure in three patients with multiple myeloma
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DOI：
10.1111/ejh.13164
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发表时间：
2018-11-01
影响因子：
3.1
通讯作者：
Bar-Yoseph, Haggai
中科院分区：
文献类型：
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作者：
Lavi, Noa;Okasha, Doaa;Bar-Yoseph, Haggai
目的：自体干细胞移植（ASCT）后，接受硼替佐米诱导方案治疗的多发性骨髓瘤（MM）患者巨细胞病毒（CMV）再激活的风险增加。关于未接受硼替佐米和ASCT治疗的MM患者巨细胞病毒感染风险的数据缺乏。方法我们在此报告3例重型预处理MM患者，接受含daratumumab的联合方案，其中ASCT已进行了很长时间，最近发生了严重的cmv相关胃肠道疾病。结果3例巨细胞病毒病程均延长，需长期抗病毒治疗。所有患者均患有巨细胞病毒结肠炎。一名患者并发巨细胞病毒性十二指肠炎，另一名患者并发巨细胞病毒性视网膜炎。结论新的骨髓瘤治疗方法延长了患者的生存期，在临床实践中发现了更多的患者在多线治疗后出现深度免疫抑制。这些患者可能出现机会性感染，这在过去是罕见的。我们的研究结果表明，达拉单抗治疗（与其他免疫抑制疗法联合使用）与严重的巨细胞病毒胃肠道疾病之间可能存在关联。需要更长的随访时间来探索新型药物如达拉单抗对新诊断和大量预处理的MM患者的长期副作用。
ObjectivesThe risk of cytomegalovirus (CMV) reactivation in multiple myeloma (MM) patients treated with bortezomib-based induction regimens is increased following autologous stem cell transplantation (ASCT). There is paucity of data regarding the risk of CMV infections in MM patients who did not receive bortezomib and ASCT.MethodsWe herein report three cases of heavily pretreated MM patients, receiving daratumumab-containing combination regimens, in whom ASCT had been performed long ago and who recently developed severe CMV-related gastrointestinal disease.ResultsAll the three patients had a prolonged CMV disease course requiring a long-term antiviral treatment. All the patients suffered from CMV colitis. One patient had concurrent CMV duodenitis and another patient had a concurrent CMV retinitis.ConclusionNovel myeloma treatments prolong patient survival and more patients with profound immunosuppression following multiple lines of therapies are seen in clinical practice. These patients may present with opportunistic infections that were rare in the past. Our findings suggest a possible association between daratumumab therapy (in combination with other immunosuppressive therapies) and severe CMV gastrointestinal disease. A longer follow-up is needed to explore long-term side effects of novel agents like daratumumab in newly diagnosed as well as heavily pretreated MM patients.