Low incidence of invasive fungal disease following CD19 chimeric antigen receptor T-cell therapy for non-Hodgkin lymphoma.

Autor:	Little JS; Division of Infectious Diseases, Brigham and Women's Hospital, Boston, MA.; Harvard Medical School, Boston, MA.; Stem Cell Transplant and Cellular Therapy, Dana-Farber Cancer Institute, Boston, MA., Aleissa MM; Division of Infectious Diseases, Brigham and Women's Hospital, Boston, MA.; Stem Cell Transplant and Cellular Therapy, Dana-Farber Cancer Institute, Boston, MA.; Department of Pharmacy, Brigham and Women's Hospital, Boston, MA., Beluch K; Division of Infectious Diseases, Brigham and Women's Hospital, Boston, MA.; Stem Cell Transplant and Cellular Therapy, Dana-Farber Cancer Institute, Boston, MA., Gonzalez-Bocco IH; Division of Infectious Diseases, Brigham and Women's Hospital, Boston, MA.; Harvard Medical School, Boston, MA.; Stem Cell Transplant and Cellular Therapy, Dana-Farber Cancer Institute, Boston, MA., Marty FM; Division of Infectious Diseases, Brigham and Women's Hospital, Boston, MA.; Harvard Medical School, Boston, MA.; Stem Cell Transplant and Cellular Therapy, Dana-Farber Cancer Institute, Boston, MA., Manne-Goehler J; Division of Infectious Diseases, Brigham and Women's Hospital, Boston, MA.; Harvard Medical School, Boston, MA.; Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA; and., Koo S; Division of Infectious Diseases, Brigham and Women's Hospital, Boston, MA.; Harvard Medical School, Boston, MA.; Stem Cell Transplant and Cellular Therapy, Dana-Farber Cancer Institute, Boston, MA., Hammond SP; Harvard Medical School, Boston, MA.; Stem Cell Transplant and Cellular Therapy, Dana-Farber Cancer Institute, Boston, MA.; Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA; and.; Division of Hematology and Oncology, Massachusetts General Cancer Center, Boston, MA., Jacobson CA; Harvard Medical School, Boston, MA.; Stem Cell Transplant and Cellular Therapy, Dana-Farber Cancer Institute, Boston, MA.
Jazyk:	angličtina
Zdroj:	Blood advances [Blood Adv] 2022 Aug 23; Vol. 6 (16), pp. 4821-4830.
DOI:	10.1182/bloodadvances.2022007474
Abstrakt:	CAR T-cell therapy has revolutionized the treatment of hematologic malignancies, although its use may be complicated by toxicities, including cytokine release syndrome (CRS), immune effector cell-associated neurotoxicity syndrome (ICANS), and infections. Invasive fungal disease (IFD) has been reported after CAR T-cell therapy, but the incidence in the absence of antifungal prophylaxis is unknown. Optimal prophylaxis strategies are widely debated. We performed a single-center retrospective study of 280 adults receiving CD19 CAR T-cell therapy for non-Hodgkin lymphoma (NHL) from December 2017 through September 2021. Patients did not receive routine antiyeast or antimold prophylaxis. IFD was identified between day of cell infusion and last follow-up. Cumulative incidence functions were calculated at 100 days and 18 months based on time to IFD, using dates of IFD-free death, initiation of salvage treatment, and hematopoietic cell transplantation as competing risks. Eight patients (2.9%) developed IFD, including 3 Pneumocystis jirovecii pneumonia, 3 invasive mold infections (IMIs), and 2 invasive yeast infections (IYIs). The 100-day cumulative incidence of IFD accounting for competing risks was 1.8% (95% confidence interval [CI], 0.8% to 4.4%). Among the 280 patients, early toxicities including CRS (85%) and ICANS (55%) and late toxicities after day 30 including grades 3 and 4 neutropenia (41%) and low CD4 T-cell count (20%) were common. IFD was rare among patients who received CD19 CAR T-cell therapy for NHL in the absence of routine antifungal prophylaxis, despite frequent toxicities. These results suggest that, in settings with low institutional rates of IFD, routine antifungal prophylaxis may not be indicated. (© 2022 by The American Society of Hematology. Licensed under Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0), permitting only noncommercial, nonderivative use with attribution. All other rights reserved.)
Databáze:	MEDLINE
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