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血液系统恶性肿瘤中使用靶向治疗继发感染的风险

Risk of Infections Secondary to the Use of Targeted Therapies in Hematological Malignancies.

作者信息

Andreescu Mihaela

机构信息

Department of Clinical Sciences, Hematology, Faculty of Medicine, Titu Maiorescu University of Bucharest, 040051 Bucharest, Romania.

Department of Hematology, Colentina Clinical Hospital, 020125 Bucharest, Romania.

出版信息

Life (Basel). 2023 May 28;13(6):1272. doi: 10.3390/life13061272.

Abstract

Concurrent infections in hematological malignancies (HM) are major contributors to adverse clinical outcomes, including prolonged hospitalization and reduced life expectancy. Individuals diagnosed with HM are particularly susceptible to infectious pathogens due to immunosuppression, which can either be inherent to the hematological disorder or induced by specific therapeutic strategies. Over the years, the treatment paradigm for HM has witnessed a tremendous shift, from broad-spectrum treatment approaches to more specific targeted therapies. At present, the therapeutic landscape of HM is constantly evolving due to the advent of novel targeted therapies and the enhanced utilization of these agents for treatment purposes. By initiating unique molecular pathways, these agents hinder the proliferation of malignant cells, consequently affecting innate and adaptive immunity, which increases the risk of infectious complications. Due to the complexity of novel targeted therapies and their associated risks of infection, it often becomes a daunting task for physicians to maintain updated knowledge in their clinical practice. The situation is further aggravated by the fact that most of the initial clinical trials on targeted therapies provide inadequate information to determine the associated risk of infection. In such a scenario, a cumulative body of evidence is paramount in guiding clinicians regarding the infectious complications that can arise following targeted therapies. In this review, I summarize the recent knowledge on infectious complications arising in the context of targeted therapies for HM.

摘要

血液系统恶性肿瘤(HM)中的合并感染是导致不良临床结局的主要因素,包括住院时间延长和预期寿命缩短。被诊断为HM的个体由于免疫抑制,对感染性病原体特别易感,这种免疫抑制可能是血液系统疾病固有的,也可能是由特定治疗策略诱导的。多年来,HM的治疗模式发生了巨大转变,从广谱治疗方法转向更具特异性的靶向治疗。目前,由于新型靶向治疗的出现以及这些药物在治疗中的更多应用,HM的治疗格局在不断演变。通过启动独特的分子途径,这些药物阻碍恶性细胞的增殖,从而影响先天免疫和适应性免疫,增加了感染并发症的风险。由于新型靶向治疗的复杂性及其相关的感染风险,医生在临床实践中保持最新知识往往是一项艰巨的任务。大多数靶向治疗的初始临床试验提供的信息不足以确定相关感染风险,这一事实进一步加剧了这种情况。在这种情况下,积累的证据对于指导临床医生了解靶向治疗后可能出现的感染并发症至关重要。在这篇综述中,我总结了关于HM靶向治疗背景下出现的感染并发症的最新知识。

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