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摘要: 近期2019新型冠状病毒变异毒株奥密克戎BA.2亚型在全球大流行,对人民的生命安全造成了较大的影响。肿瘤患者因疾病自身或治疗的原因处于免疫失衡状态,更易罹患2019冠状病毒病(coronavirus disease 2019,COVID-19),并且感染后病死率高于正常人群。肿瘤患者和正常人群在感染病毒后免疫状态有所不同,主要表现为两个方面,一方面是各类细胞因子不受调节的过度释放,另一方面是体液免疫和细胞免疫的后继无力,故抗肿瘤治疗策略也应进行相应的调整。现对相关的研究进展做一综述,为这类特殊人群的治疗提供参考。Abstract: Recently, 2019 novel coronavirus variant strain Omicron BA.2 subtype is in a global pandemic and of great danger to people’s safety. Tumor patients are in a state of immune imbalance due to the disease itself or treatment, so they are more likely to suffer from coronavirus disease 2019 (COVID-19), and the mortality after infection is higher than normal people. Immune status differs between tumor patients and normal population after virus infection, which includes two aspects: one is the unregulated excessive release of various cytokines, and the other is the subsequent weakness of humoral and cellular immunity. Therefore, the anti-tumor treatment strategy should be adjusted accordingly. A review of the relevant research progress is presented to provide reference for the treatment of this special population.
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Key words:
- coronavirus disease 2019 (COVID-19) /
- tumor /
- immune /
- treatment
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表 1 肿瘤患者各个治疗不同阶段疫苗接种建议
肿瘤类型 治疗方式 接种时机 疫苗种类 血液系统肿瘤 骨髓移植(自体、异体) 移植后3个月以上 WHO推荐的疫苗类型,第三针或第四针最好采用不同技术路线的疫苗 细胞免疫治疗(如CAR-T) 治疗后3个月以上 化疗 末次化疗后3个月以上 靶向治疗(如抗CD20单抗) 抗CD20单抗结束治疗后6个月以上 实体瘤 手术 手术并发症恢复后 放疗 任何时期 化疗 末次化疗后淋巴细胞恢复正常 靶向治疗 任何时期 内分泌治疗 任何时期 免疫治疗 末次治疗后3个月以上 注:骨髓移植或细胞免疫治疗需要3个月左右的免疫重建,因此建议3个月后接种疫苗;血液肿瘤一般采用强化疗方案,建议末次化疗后3个月接种;CD20单抗可导致B细胞长久封闭,建议末次用药后6个月根据B细胞情况而定,如果采用美罗华长期维持,不建议接种疫苗;疫苗接种可能加重irAE,免疫治疗患者建议末次治疗后3个月(疫苗接种前都需要检测血常规及各项免疫指标保证淋巴细胞计数及炎症指标在正常范围内) -
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