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Kawata K, Shima H, Shinjoh M, Yamazaki F, Kurosawa T, Yaginuma M, Takada H, Shimada H. Pneumocystis jirovecii pneumonia after CD4+ T-cell recovery subsequent to CD19-targeted chimeric antigen receptor T-cell therapy: A case report and brief review of literature. Cancer Rep (Hoboken) 2023; 6:e1885. [PMID: 37563749 PMCID: PMC10598253 DOI: 10.1002/cnr2.1885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 07/20/2023] [Accepted: 07/28/2023] [Indexed: 08/12/2023] Open
Abstract
BACKGROUND CD19-targeted chimeric antigen receptor (CAR)-T cell therapy involves administration of patient-derived T cells that target B cells, resulting in B-cell depletion and aplasia. In immunity against Pneumocystis jirovecii (Pj), CD4+ T cells and, more recently, B cells, are generally considered important. Antigen presentation by B cells to CD4+ T cells is particularly important. Trimethoprim-sulfamethoxazole (TMP/SMX) for Pj pneumonia (PJP) prophylaxis is generally discontinued when the CD4+ T-cell count is >200/μL. Here we report the first case, to our knowledge, of PJP in a patient with a CD4+ T cell count of >200/μL after CAR-T cell therapy. CASE A 14-year-old girl developed hemophagocytic lymphohistiocytosis (HLH) after cord blood transplantation (CBT) for relapsed precursor B-cell acute lymphoblastic leukemia (B-ALL). Twenty-one months after CBT, she was diagnosed with combined second relapse in the bone marrow and central nervous system. The patient was treated with CD19-targeted CAR-T cell therapy for the relapse. After CAR-T cell therapy, the patient remained in remission and continued to receive TMP/SMX for PJP prophylaxis. Seven months after CAR-T cell therapy, CD4+ T cells recovered and TMP/SMX was discontinued. The B-cell aplasia persisted. Ten months after CAR-T cell therapy, the patient developed PJP. The patient was also considered to have macrophage hyperactivation at the onset of PJP. Treatment with immunoglobulin, TMP/SMX, and prednisolone was initiated, and the patient's symptoms rapidly ameliorated. CONCLUSION The patient in the present case developed PJP despite a CD4+ T-cell count of >200/μL after CAR-T cell therapy, probably because of inadequate CD4+ T-cell activation caused by B-cell depletion after CAR-T cell therapy and repeated abnormal macrophage immune responses after CBT. It is important to determine the duration of TMP/SMX for prophylaxis after CAR-T cell therapy according to each case, as well as the CD4+ T-cell count.
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Affiliation(s)
- Kento Kawata
- Department of PediatricsKeio University School of MedicineTokyoJapan
| | - Haruko Shima
- Department of PediatricsKeio University School of MedicineTokyoJapan
| | - Masayoshi Shinjoh
- Department of PediatricsKeio University School of MedicineTokyoJapan
| | - Fumito Yamazaki
- Department of PediatricsKeio University School of MedicineTokyoJapan
| | - Takumi Kurosawa
- Department of PediatricsKeio University School of MedicineTokyoJapan
| | - Mizuki Yaginuma
- Department of PediatricsKeio University School of MedicineTokyoJapan
| | - Hiroshi Takada
- Department of PediatricsKeio University School of MedicineTokyoJapan
| | - Hiroyuki Shimada
- Department of PediatricsKeio University School of MedicineTokyoJapan
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Xiao C, Wang X. Overseas Chinese Returnees' Swindler Syndrome and Their Entrepreneurial Education Under Psychological Resilience. Front Psychol 2022; 12:747687. [PMID: 35069326 PMCID: PMC8780547 DOI: 10.3389/fpsyg.2021.747687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 11/24/2021] [Indexed: 11/24/2022] Open
Abstract
The study aims to explore the entrepreneurship education of overseas Chinese returnees with the swindler syndrome through psychological resilience. First, a questionnaire survey is conducted to analyze the current situations of entrepreneurship education of overseas Chinses returnees and college students, and it is found that the entrepreneurship education received by overseas Chinese returnees is more advanced and perfect than that by domestic students, which makes overseas Chinese returnees have the ability to solve the problems in the process of entrepreneurship, realizing their entrepreneurial dream. However, the emergence of swindler syndrome changes the self-awareness and psychology of these returnees, which is improved through appropriate entrepreneurship education under resilience analysis. The results show that entrepreneurial resilience and entrepreneurial optimism covered by psychological resilience have a significant positive impact on entrepreneurial intention, indicating that entrepreneurial resilience and entrepreneurial optimism can enhance individual’s entrepreneurial intention. The scores of the subjects with the experience of studying abroad are higher than those without such experience, indicating that overseas Chinese returnees have stronger resilience and more optimistic attitudes in the face of difficulties and setbacks, which provides a new perspective for in-depth analysis of Chinese returnees’ entrepreneurship education and promotes the development of entrepreneurship education in colleges and universities in China.
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Affiliation(s)
- Can Xiao
- College of Education, Washington State University, Pullman, WA, United States
| | - Xiaoya Wang
- College of Education, Washington State University, Pullman, WA, United States
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Laberko A, Burlakov V, Maier S, Abinun M, Skinner R, Kozlova A, Suri D, Lehmberg K, Müller I, Balashov D, Novichkova G, Holzinger D, Gennery AR, Shcherbina A. HSCT is effective in patients with PSTPIP1-associated myeloid-related proteinemia inflammatory (PAMI) syndrome. J Allergy Clin Immunol 2020; 148:250-255.e1. [PMID: 33338535 DOI: 10.1016/j.jaci.2020.11.043] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 11/06/2020] [Accepted: 11/12/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND Proline-serine-threonine phosphatase-interacting protein 1-associated myeloid-related proteinemia inflammatory (PAMI) syndrome is a novel genetic disorder, causing hypercalprotectinemia and hyperzincemia with inflammatory complications accompanied by cytopenia. Immunosuppressive and/or anticytokine therapy is of limited effect. OBJECTIVES Because of cytokine production in nonhematopoietic tissues, the potential therapeutic effect of allogeneic hematopoietic stem cell transplantation (HSCT) in autoinflammatory disorders, including PAMI syndrome, has remained uncertain. METHODS Five patients with PAMI syndrome underwent allogeneic HSCT with myeloablative (4) or reduced-intensity (1) conditioning regimens. Lack of PAMI disease control served as indication for the HSCT in 4 patients and myelodysplastic syndrome development in 1. RESULTS All 5 patients engrafted; however, 1 patient at day +13 developed hemophagocytic syndrome, followed by graft rejection at day +17. After 5.5 months, a second HSCT was performed from an alternative donor. A further patient at day +116 developed an intense inflammatory syndrome with significant serositis and severe mitral and aortic valve regurgitation, controlled with adalimumab, tacrolimus, and prednisone. No other noninfectious inflammatory episodes, or acute or chronic graft-versus-host disease, occurred in any patient. At the last follow-up (median, 2.2 years), all 5 patients have predominantly or complete donor chimerism and adequate immune recovery and are free of any PAMI symptoms. CONCLUSIONS Allogeneic HSCT seems to be an effective option to cure cytopenia and severe autoinflammation in PAMI syndrome and may be a curative option for other proline-serine-threonine phosphatase-interacting protein 1-associated inflammatory disorders with poor therapeutic control.
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Affiliation(s)
- Alexandra Laberko
- Department of Immunology, Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology, Moscow, Russia; Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom.
| | - Vasiliy Burlakov
- Department of Immunology, Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology, Moscow, Russia
| | - Sarah Maier
- Division of Pediatric Stem Cell Transplantation and Immunology, Department of Pediatric Hematology and Oncology, University Medical Center Eppendorf, Hamburg, Germany
| | - Mario Abinun
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom; Great North Children's Hospital, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Roderick Skinner
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom; Great North Children's Hospital, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Anna Kozlova
- Department of Immunology, Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology, Moscow, Russia
| | - Deepti Suri
- Great North Children's Hospital, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Kai Lehmberg
- Division of Pediatric Stem Cell Transplantation and Immunology, Department of Pediatric Hematology and Oncology, University Medical Center Eppendorf, Hamburg, Germany
| | - Ingo Müller
- Division of Pediatric Stem Cell Transplantation and Immunology, Department of Pediatric Hematology and Oncology, University Medical Center Eppendorf, Hamburg, Germany
| | - Dmitry Balashov
- Department of Hematopoietic Stem Cell Transplantation, Dmitry Rogachev National Medical Center of Pediatric Hematology, Oncology and Immunology, Moscow, Russia
| | - Galina Novichkova
- Department of Hematology, Dmitry Rogachev National Medical Center of Pediatric Hematology, Oncology and Immunology, Moscow, Russia
| | - Dirk Holzinger
- Department of Pediatric Hematology-Oncology, University of Duisburg-Essen, Essen, Germany
| | - Andrew R Gennery
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom; Great North Children's Hospital, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Anna Shcherbina
- Department of Immunology, Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology, Moscow, Russia
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Post-transplant Hemophagocytic Lymphohistiocytosis in Benign Hematological Disorders: Experience of 4 Cases with Review of Literature. Indian J Hematol Blood Transfus 2020; 36:674-679. [PMID: 33100709 DOI: 10.1007/s12288-020-01258-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Accepted: 01/28/2020] [Indexed: 10/24/2022] Open
Abstract
Post transplant Hemophagocytic lymphohistiocytosis (HLH) is a form of secondary HLH, which can be either early onset or late onset and is associated with significant morbidity and mortality. With the increasing popularity of post transplant cyclophosphamide based haploidentical stem cell transplantation (SCT), post transplant HLH is becoming a significant complication especially in benign hematological disorders. Methods: We present 4 cases of post transplant HLH occurring in 2 cases of severe aplastic anemia (post haploidentical SCT) and 2 cases of thalassemia major (post matched sibling SCT). All 4 cases had early onset variety with dismal prognosis. Conclusion: Post-transplant HLH is an important entity in benign hematological disorders, which needs to be identified early and treated promptly with steroids, monoclonal agents or immunosuppressive therapy. Serum ferritin levels are an important biomarker and help in monitoring response.
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Epperly R, Furman W, Hines M, Santiago T, Li Y, Madden R, Mamcarz E, Cervi D, Federico S, Triplett B, Talleur A. Secondary hemophagocytic syndrome after autologous hematopoietic cell transplant and immune therapy for neuroblastoma. Pediatr Blood Cancer 2019; 66:e27964. [PMID: 31407508 DOI: 10.1002/pbc.27964] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Revised: 07/19/2019] [Accepted: 07/27/2019] [Indexed: 02/06/2023]
Abstract
Secondary hemophagocytic syndrome (HPS) has been described after autologous hematopoietic cell transplant (AutoHCT). We report two cases of secondary HPS after novel consolidation therapy for high-risk neuroblastoma as part of an institutional phase 2 trial incorporating immunotherapy into a "standard" AutoHCT regimen. Both patients developed liver dysfunction beyond expected course of hepatic veno-occlusive disease, coagulopathy, hyperferritinemia, and when evaluated, elevated soluble interleukin-2 receptor and hemophagocytosis. These cases highlight the need for clinicians to have a high index of suspicion for immune-related complications in patients receiving immune therapies.
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Affiliation(s)
- Rebecca Epperly
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Wayne Furman
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Melissa Hines
- Department of Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Teresa Santiago
- Department of Pathology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Ying Li
- Department of Bone Marrow Transplantation and Cellular Therapy, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Renee Madden
- Department of Bone Marrow Transplantation and Cellular Therapy, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Ewelina Mamcarz
- Department of Bone Marrow Transplantation and Cellular Therapy, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - David Cervi
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Sara Federico
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Brandon Triplett
- Department of Bone Marrow Transplantation and Cellular Therapy, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Aimee Talleur
- Department of Bone Marrow Transplantation and Cellular Therapy, St. Jude Children's Research Hospital, Memphis, Tennessee
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