RESUMO
This article reports two cases of children with B-cell acute lymphoblastic leukemia (B-ALL) complicated by invasive fungal disease (IFD) who received bridging treatment using blinatumomab. Case 1 was a 4-month-old female infant who experienced recurrent high fever and limb weakness during chemotherapy. Blood culture was negative, and next-generation sequencing (NGS) of peripheral blood, bronchoalveolar lavage fluid, and cerebrospinal fluid were all negative. Chest CT and cranial MRI revealed obvious infection foci. Case 2 was a 2-year-old male patient who experienced recurrent high fever with multiple inflammatory masses during chemotherapy. Candida tropicalis was detected in peripheral blood and abscess fluid using NGS, while blood culture and imaging examinations showed no obvious abnormalities. After antifungal and blinatumomab therapy, both cases showed significant improvement in symptoms, signs, and imaging, and B-ALL remained in continuous remission. The report indicates that bridging treatment with blinatumomab in children with B-ALL complicated by IFD can rebuild the immune system and control the underlying disease in the presence of immunosuppression and severe fungal infection.
Assuntos
Anticorpos Biespecíficos , Infecções Fúngicas Invasivas , Leucemia-Linfoma Linfoblástico de Células Precursoras B , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Anticorpos Biespecíficos/uso terapêutico , Infecções Fúngicas Invasivas/tratamento farmacológico , Leucemia-Linfoma Linfoblástico de Células Precursoras B/complicações , Leucemia-Linfoma Linfoblástico de Células Precursoras B/tratamento farmacológico , Indução de RemissãoRESUMO
A method based on ultra performance liquid chromatography-quadrupole/electrostatic field orbitrap mass spectrometry was developed for the rapid determination of 13 ß-blockers in health foods. The MS fragmentation pathways of the analytes were subsequently investigated. The optimal MS conditions, extraction solvents, mobile phases, and matrix effects were evaluated in detail. The samples were extracted with methanol, filtered by high-speed centrifugation and ultrasonic treatment, and then separated on an Acquity UPLC BEH C18 column (100 mm×2.1 mm, 1.7 µm) with gradient elution using acetonitrile and 0.1% (v/v) formic acid aqueous solution as mobile phases. MS analysis was conducted in positive-ion mode, and the data were collected using full mass and data-dependent MS2 scans (Full MS/dd-MS2). The efficient separation and high-precision primary and secondary scanning of the 13 ß-blockers in health foods were realized within 10 min, and accurate mass numbers and fragment-ion information were obtained. The methodological validation showed good linear relationships in the range of 0.5-100 µg/L, with correlation coefficients (r)≥0.9912. The limits of detection ranged from 1 to 10 µg/kg. When the standard substances were added to the blank sample in the amount of 10-200 µg/kg, the recoveries were in the range of 75.3%-108.4%, and the relative standard deviations ranged from 0.9% to 10.0% (n=6). The method was used to screen 30 batches of commercially available health foods, and none of the 13 ß-blockers was detected. The proposed method is fast, accurate, and sensitive, and can be used for the rapid determination of ß-blockers in health foods.