决定异体 CAR T 细胞排斥与扩增的细胞和分子机制
Cellular and molecular mechanisms determining allogeneic CAR T cell rejection and expansion.
我们评估了11例接受单一批次cemacabtagene ansegedleucel(cema-cel)治疗的大B细胞淋巴瘤患者,cemacabtagene ansegedleucel是一种异体抗CD19 CAR T产品。
英文原题:Hematologic Malignancies Diagnosed in the Context of the mRNA COVID-19 Vaccination Campaign: A Report of Two Cases.
基于mRNA的疫苗的安全性是不争的事实。在大多数情况下,疑似具有潜在侵袭性副作用的病例均被排除,证实为短暂的疫苗接种后反应。临床医生应保持警惕,报告在mRNA COVID-19疫苗接种背景下出现的任何潜在侵袭性表现,例如这些血液系统恶性肿瘤病例,以促进对COVID-19疫苗特定作用机制的进一步研究,并为患者提供最佳的医疗护理。
在过去两年中,COVID-19 大流行导致全球数百万人因相关疾病死亡。科学界面对这一全球挑战所做的努力取得了杰出成就。因此,在一年内,针对 SARS-CoV-2 病毒感染的新型 mRNA 疫苗被推出,在普通人群中提供了高效保护,并显示出非常好的安全性。然而,对于任何新医疗产品的长期安全性而言,接种后的临床数据收集是一个持续过程。本文的目的是介绍两例血液系统恶性肿瘤:弥漫性大 B 细胞非霍奇金淋巴瘤和 T/NK 细胞淋巴瘤,均在接种 mRNA COVID-19 疫苗后不久被诊断。
病例1:一名女性患者因接种第二剂BNT162b2 COVID-19疫苗后一周内出现的可疑颈部肿块入院。手术切除后对标本进行病理学评估,确诊为弥漫性大B细胞非霍奇金淋巴瘤。病例2:一名男性患者因接种首剂BNT162b2 COVID-19疫苗后第三天出现的多发性口腔溃疡性病变入院。这些病变呈进行性特征,并在随后数月内并发反复发作的严重口腔出血,需要输血治疗。对病变进行切开活检及标本病理学评估,确诊为T/NK细胞淋巴瘤。
BACKGROUND: During the last two years, the COVID-19 pandemic led to millions of disease-related deaths worldwide. The efforts of the scientific community facing this global challenge resulted in outstanding achievements. Thus, within one year, new mRNA-based vaccines against SARS-CoV-2 viral infection were released, providing highly efficient protection and showing a very good safety profile in the general population. However, clinical data collection after vaccination is a continuous process for the long-term safety of any new medical product. The aim of our paper is to present two cases of hematological malignancies: diffuse large B-cell non-Hodgkin lymphoma and T/NK-cell lymphoma, diagnosed shortly after the administration of the mRNA COVID-19 vaccine. METHODS AND RESULTS: Case 1: A female patient was admitted with a suspicious cervical mass that emerged within one week after the administration of second dose of the BNT162b2 COVID-19 vaccine. Surgical removal followed by pathology assessment of the specimen confirmed the diagnosis of diffuse large B-cell non-Hodgkin lymphoma. Case 2: A male patient was admitted with multiple ulcerative oral lesions arising on the third day after the initial dose of the BNT162b2 COVID-19 vaccine. These lesions had a progressive character and during the following months were complicated with repetitive episodes of heavy oral bleeding, requiring blood transfusions. The incisional biopsy of the lesions and pathological assessment of the specimens confirmed the diagnosis of T/NK-cell lymphoma. CONCLUSIONS: The safety profile of the mRNA-based vaccines is an undeniable fact. In most cases, suspicions of potentially aggressive side effects were ruled out, proving to be transient post-vaccine reactions. Clinicians should remain alert to report any potentially aggressive manifestations emerging in the context of mRNA COVID-19 vaccination, such as these cases of hematological malignancies, in order to promote additional investigations on the particular mechanisms of action of COVID-19 vaccines and to provide the best medical care to the patients.
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