对于复发难治性 B 细胞急性淋巴细胞白血病 (B-ALL) 患者，博纳吐单抗作为单药已表现出优于挽救性化疗的优势，且安全性和有效性可控。尽管已知博纳吐单抗会出现预期的药物毒性，包括细胞因子释放综合征 (CRS) 和神经毒性，但之前只有一份关于 blinatumomab 引起的巨噬细胞激活综合征 (MAS) 的报道。病例介绍：我们报告了首例成人博纳吐单抗诱导的 MAS 病例。患者在第二个周期的博纳吐莫单抗治疗中出现发烧、咳嗽和虚弱症状。全血细胞计数显示严重白细胞减少症，综合代谢组显示碱性磷酸酶、AST、ALT、LDH 升高和与 MAS 一致的高铁蛋白血症。患者出现 MAS 时已处于 MRD 阴性缓解状态。她对停止用药并服用托珠单抗和地塞米松做出了迅速反应。她能够以 9 mcg/天的剂量重新开始 blinatumomab 治疗，并且没有症状复发。尽管 MAS 与 blinatumomab 没有预期的关联，但 CRS 的风险却是存在的。在这种情况下，继发性 MAS 可能与其他高炎症性疾病具有相同的机制。治疗包括扣押博纳吐单抗等违规药物，以及给予托珠单抗和地塞米松。未来的研究需要预测哪些患者在接受类似 T 细胞疗法后发生 MAS 的风险最高。© 2024。作者。

Blinatumomab as a single agent has demonstrated superiority over salvage chemotherapy in patients with relapsed and refractory B-cell acute lymphoblastic leukemia (B-ALL), with manageable safety and efficacy. Though known to have anticipated drug toxicities including cytokine release syndrome (CRS) and neurotoxicity, there is only one prior report of macrophage activating syndrome (MAS) due to blinatumomab. Case Presentation: We report the first case of blinatumomab-induced MAS in an adult. The patient presented with fever, cough, and weakness on the second cycle of blinatumomab. Complete blood count was notable for severe leukopenia, with comprehensive metabolic panel notable for elevated alkaline phosphatase, AST, ALT, LDH, and hyperferritinemia consistent with MAS. The patient was already in MRD-negative remission at presentation with MAS. She responded rapidly to withholding the drug and administration of both tocilizumab and dexamethasone. She was able to restart therapy with blinatumomab dosed at 9 mcg/day with no recurrence of symptoms. Though MAS is not an expected association with blinatumomab, the risk for CRS is. Secondary MAS in this case likely shares a mechanism with other hyperinflammatory conditions. Management includes holding the offending agent, like blinatumomab, and administering tocilizumab and dexamethasone. Future research will be needed to predict which patients are at highest risk to develop MAS after similar T-cell therapies.© 2024. The Author(s).