Incidence and prophylaxis of herpes zoster in relapsed or refractory B-cell lymphoma patients after CD19-specific CAR-T cell therapy

Liu, Hui; Li, Ping; Zhao, Ailin; Lei, Wen; Liang, Aibin; Qian, W.

doi:10.1080/10428194.2021.2010062

Cited by 4 publications

(3 citation statements)

References 12 publications

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“…The incidence of viral infections after the first month following CAR-T cell infusion ranged from 9.2 to 28%. In addition, many patients have profound CD4 lymphopenia associated with B-cell aplasia, and reactivation of herpesviruses is frequently observed 6–12 months after CAR-T cell infusion [ 94 ]. In addition, cytomegalovirus reactivation has been reported in 1–2% of patients.…”

Section: Car-t Cell Therapymentioning

confidence: 99%

Infectious Complications of Targeted Therapies for Solid Cancers or Leukemias/Lymphomas

Pilmis

Kherabi

Huriez

et al. 2023

Cancers

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Background: Infections are well known complications of some targeted drugs used to treat solid organ cancer and hematological malignancies. Furthermore, Individual patient risk factors are associated with underlying pathologies, concomitant immunosuppressive treatment, prior treatment and use of anti-infective prophylaxis. Immune-related adverse events (irAEs) are frequent among patients treated with new targeted drugs. Objectives: In this narrative review, we present the current state of knowledge concerning the infectious complications occurring in patients treated with immune checkpoint inhibitors (ICIs), Bruton’s tyrosine kinase (BTK) inhibitors, phosphatidylinositol 3-kinase (PI3K) inhibitors, antiapoptotic protein BCL-2 inhibitors, Janus kinase inhibitors or CAR-T cell infusion. Sources: We searched for studies treating infectious complications of ICIs, BTK inhibitors, PI3K inhibitors, antiapoptotic protein BCL-2 inhibitors and CAR-T cell therapy. We included randomized, observational studies and case reports. Content: Immune-related adverse events (irAEs) are frequent among patients treated with new targeted drugs. Treatment of irAEs with corticosteroids and other immunosuppressive agents can lead to opportunistic infections. Bruton’s tyrosine kinase (BTK) inhibitors are associated with higher rate of infections, including invasive fungal infections. Implications: Infections, particularly fungal ones, are common in patients treated with BTK inhibitors even though most of the complications occurring among patients treated by ICIs or CART-cells infusion are associated with the treatment of side effects related to the use of these new treatments. The diagnosis of these infectious complications can be difficult and may require extensive investigations.

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Section: Car-t Cell Therapymentioning

confidence: 99%

Infectious Complications of Targeted Therapies for Solid Cancers or Leukemias/Lymphomas

Pilmis

Kherabi

Huriez

et al. 2023

Cancers

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“…The incidence of VZV in chimeric antigen receptor‐T cell therapy (CAR‐T) patients is not well known 34,35 . In a study of 54 patients who received CD19 targeted CAR‐T cell therapy, the incidence rate was 14.8% among the entire treatment cohort, and 25.8% among those that survived 1 year with a median onset time of 15.5 months 36 …”

Section: Varicella Zoster Virusmentioning

confidence: 99%

Hematopoietic stem cell transplantation and the noncytomegalovirus herpesviruses

Wormser,

Agudelo Higuita,

Ramaswami

et al. 2023

Transplant Infectious Dis

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Although hematopoietic stem cell transplantation (HSCT) and other cellular therapies have significantly improved outcomes in the management of multiple hematological and nonhematological malignancies, the resulting impairment in humoral and cellular response increases the risk for opportunistic infection as an undesirable side effect. With their ability to establish latent infection and reactivate when the host immune system is at its weakest point, the Herpesviridae family constitutes a significant proportion of these opportunistic pathogens. Despite recent advancements in preventing and managing herpesvirus infections, they continue to be a common cause of significant morbidity and mortality in transplanted patients. Herein, we aim to provide and update on herpesvirus other than cytomegalovirus (CMV) affecting recipients of HSCT and other cellular therapies.

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“…In a multicenter retrospective analysis performed by Liu et al involving patients undergoing CD19 CAR-T cell therapy for relapsed or refractory lymphoma, VZV reactivation was seen at median time of 15.5 months after CD19 CAR-T cell therapy, with a range of 8-20 months. They report a significantly lower incidence of VZV reactivation among patients on antiviral prophylaxis 23.…”

mentioning

confidence: 97%

Infectious complications among CD19 CAR‐T cell therapy recipients: A single‐center experience

Walker,

Zimmer,

Stohs

et al. 2023

Transplant Infectious Dis

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BackgroundCD19 chimeric antigen receptor (CAR)‐T cell therapy has emerged as an effective treatment in those with refractory or relapsed lymphoma. CD19 CAR‐T cell therapy can cause direct and indirect toxic adverse effects and increased risk for infection. Infectious complications and optimal antimicrobial prophylaxis strategies are an ongoing area of investigation.MethodsA single‐center retrospective cohort study was conducted to review recipients of CD19 CAR‐T cell therapy between April 2018 and December 2020. Patient characteristics and clinical outcomes were extracted from the electronic health records.ResultsInfectious complications were identified in 18/50 (36%) recipients with 31 episodes of infection. The median time to infection was 225 days (range 0–614). Bacterial infections were most common with bloodstream infection followed by sinusitis and skin and soft tissue infection. Eight viral infections were identified, most being respiratory viral illnesses. Two fungal infections were identified: Pneumocystis jirovecii pneumonia (PJP) and disseminated fusariosis. Seventeen infections (54.8%) were classified as severe: leading to death, requiring hospitalization, need for empiric intravenous antibiotics, or significant alteration in hospital course. No characteristics were found to be statistically significant risks for infection, although a trend toward significance was seen in prior autologous stem cell transplant recipients (p = .12) and those with recurrent neutropenia (p = .14). Three patients (6%) died from infection.ConclusionInfections were common after CD19 CAR‐T cell therapy and occurred beyond the first year. Further multicenter studies are needed to define infectious risks and optimize antimicrobial prophylaxis recommendations in recipients of CD19 CAR‐T cell therapy. image

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Incidence and prophylaxis of herpes zoster in relapsed or refractory B-cell lymphoma patients after CD19-specific CAR-T cell therapy

Cited by 4 publications

References 12 publications

Infectious Complications of Targeted Therapies for Solid Cancers or Leukemias/Lymphomas

Infectious Complications of Targeted Therapies for Solid Cancers or Leukemias/Lymphomas

Hematopoietic stem cell transplantation and the noncytomegalovirus herpesviruses

Infectious complications among CD19 CAR‐T cell therapy recipients: A single‐center experience

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