Outcome of Pneumocystis Jirovecii pneumonia (PcP) in post-CAR-T patients with hematological malignancies.
Humans
Pneumonia, Pneumocystis
/ immunology
Male
Female
Middle Aged
Retrospective Studies
Hematologic Neoplasms
/ complications
Pneumocystis carinii
Adult
Immunocompromised Host
Immunotherapy, Adoptive
/ adverse effects
Aged
Treatment Outcome
Opportunistic Infections
/ microbiology
Trimethoprim, Sulfamethoxazole Drug Combination
/ therapeutic use
Young Adult
Adoptive cell therapy
Hematological malignancy
Pneumocystis pneumonia
Primary prophylaxis
Journal
BMC infectious diseases
ISSN: 1471-2334
Titre abrégé: BMC Infect Dis
Pays: England
ID NLM: 100968551
Informations de publication
Date de publication:
13 Oct 2024
13 Oct 2024
Historique:
received:
20
06
2024
accepted:
05
09
2024
medline:
14
10
2024
pubmed:
14
10
2024
entrez:
13
10
2024
Statut:
epublish
Résumé
Pneumocystis jirovecii pneumonia (PcP) is an opportunistic infection associated with immunocompromised patients. The development of novel immunotherapies has promoted the incidence of PcP. This study describes the clinical course and outcome of PcP in chimeric antigen receptor (CAR) T cell recipients with hematological malignancies. This is a retrospective case series of CAR-T recipients diagnosed with PcP in our center. The cases were all confirmed by metagenomic next-generation sequencing of clinical samples. The demographic, clinical, and outcome data were retrieved from the patients' medical charts and electronic medical record system. In total, 8 cases of PcP were identified. The underlying malignancies included T-acute lymphoblastic leukemia (ALL) (n = 1), diffuse large B cell lymphoma (DLBCL) (n = 4), and B-ALL (n = 3). One patient received short-term sulfamethoxazole-trimethoprim (SMZ-TMP) while the others had no prophylaxis. Four patients had neutropenia/lymphopenia at the diagnosis of PcP, and two patients had immunosuppressants within one month before PcP manifestation. The median time from CAR-T infusion to PcP diagnosis was 98.5 days (range 52-251). Seven patients recovered from PcP after proper management while one died of septic shock. PcP can occur after different CAR-T product, and the long-term depletion of immune cells seems to be related to PcP. SMZ-TMP is effective in this setting. More real-world experience of CAR-T therapy is required to assess the incidence and outcome of PcP in this population.
Sections du résumé
BACKGROUND
BACKGROUND
Pneumocystis jirovecii pneumonia (PcP) is an opportunistic infection associated with immunocompromised patients. The development of novel immunotherapies has promoted the incidence of PcP. This study describes the clinical course and outcome of PcP in chimeric antigen receptor (CAR) T cell recipients with hematological malignancies.
METHODS
METHODS
This is a retrospective case series of CAR-T recipients diagnosed with PcP in our center. The cases were all confirmed by metagenomic next-generation sequencing of clinical samples. The demographic, clinical, and outcome data were retrieved from the patients' medical charts and electronic medical record system.
RESULTS
RESULTS
In total, 8 cases of PcP were identified. The underlying malignancies included T-acute lymphoblastic leukemia (ALL) (n = 1), diffuse large B cell lymphoma (DLBCL) (n = 4), and B-ALL (n = 3). One patient received short-term sulfamethoxazole-trimethoprim (SMZ-TMP) while the others had no prophylaxis. Four patients had neutropenia/lymphopenia at the diagnosis of PcP, and two patients had immunosuppressants within one month before PcP manifestation. The median time from CAR-T infusion to PcP diagnosis was 98.5 days (range 52-251). Seven patients recovered from PcP after proper management while one died of septic shock.
CONCLUSION
CONCLUSIONS
PcP can occur after different CAR-T product, and the long-term depletion of immune cells seems to be related to PcP. SMZ-TMP is effective in this setting. More real-world experience of CAR-T therapy is required to assess the incidence and outcome of PcP in this population.
Identifiants
pubmed: 39396970
doi: 10.1186/s12879-024-09893-x
pii: 10.1186/s12879-024-09893-x
doi:
Substances chimiques
Trimethoprim, Sulfamethoxazole Drug Combination
8064-90-2
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1147Subventions
Organisme : National Natural Science Foundation of China,China
ID : 81800178
Organisme : National Natural Science Foundation of China
ID : 81730008
Organisme : National Natural Science Foundation of China
ID : 82270234
Organisme : National Key Research and Development Program of China
ID : 2022YFC2304505
Informations de copyright
© 2024. The Author(s).
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