1
|
Arya S, Shahid Z. Overview of infectious complications among CAR T- cell therapy recipients. Front Oncol 2024; 14:1398078. [PMID: 39026972 PMCID: PMC11255439 DOI: 10.3389/fonc.2024.1398078] [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: 03/08/2024] [Accepted: 06/04/2024] [Indexed: 07/20/2024] Open
Abstract
Chimeric antigen receptor-modified T cell (CAR T-cell) therapy has revolutionized the management of hematological malignancies. In addition to impressive malignancy-related outcomes, CAR T-cell therapy has significant toxicity-related adverse events, including cytokine release syndrome (CRS), immune effector cell associated neurotoxicity syndrome (ICANS), immune effector cell-associated hematotoxicity (ICAHT), and opportunistic infections. Different CAR T-cell targets have different epidemiology and risk factors for infection, and these targets result in different long-term immunodeficiency states due to their distinct on-target and off- tumor effects. These effects are exacerbated by the use of multimodal immunosuppression in the management of CRS and ICANS. The most effective course of action for managing infectious complications involves determining screening, prophylactic, and monitoring strategies and understanding the role of immunoglobulin replacement and re-vaccination strategies. This involves considering the nature of prior immunomodulating therapies, underlying malignancy, the CAR T-cell target, and the development and management of related adverse events. In conclusion, we now have an increasing understanding of infection management for CAR T-cell recipients. As additional effector cells and CAR T-cell targets become available, infection management strategies will continue to evolve.
Collapse
Affiliation(s)
- Swarn Arya
- Infectious Disease Service, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Zainab Shahid
- Infectious Disease Service, Memorial Sloan Kettering Cancer Center, New York, NY, United States
- Department of Medicine, Weill Cornell School of Medicine, New York, NY, United States
| |
Collapse
|
2
|
Bharuka V, Meshram R, Munjewar PK. Comprehensive Review of Urinary Tract Infections in Renal Transplant Recipients: Clinical Insights and Management Strategies. Cureus 2024; 16:e53882. [PMID: 38465031 PMCID: PMC10924982 DOI: 10.7759/cureus.53882] [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: 10/24/2023] [Accepted: 02/04/2024] [Indexed: 03/12/2024] Open
Abstract
Urinary tract infections (UTIs) pose a significant challenge in the care of renal transplant recipients. This comprehensive review explores this population's multifaceted landscape of UTIs, emphasizing the importance of early diagnosis and tailored management strategies. Renal transplant recipients face an elevated risk of UTIs due to immunosuppression, altered urinary tract anatomy, and complex comorbidities. Complications of UTIs can lead to graft dysfunction and systemic illness, underscoring the need for effective management. The emergence of multidrug-resistant uropathogens adds complexity to treatment, highlighting the importance of targeted antibiotic therapy. Antibiotics are the most commonly prescribed drugs for UTIs, with nitrofurantoin, fosfomycin, amoxicillin, and amoxicillin-clavulanate potassium being some of the commonly used antibiotics. However, the emergence of multidrug-resistant uropathogens has led to the exploration of alternative treatments, such as bacteriophage therapy, as a potential alternative against multidrug-resistant uropathogenic bacteria. Analgesics such as phenazopyridine can be prescribed to relieve discomfort associated with UTIs. Estrogen therapy has also been suggested as a potential treatment option for UTIs, particularly in postmenopausal women. Trimethoprim-sulfamethoxazole or trimethoprim is recommended as first-line therapy for uncomplicated UTIs. The choice of drug and therapy for UTIs depends on the severity of the infection, the causative organism, and the presence of antibiotic resistance. Preventive measures encompass pre-transplant evaluation, perioperative strategies, post-transplant follow-up, and vaccination. A multidisciplinary approach involving transplant specialists, infectious disease experts, pharmacists, and patient engagement is vital for successful care. The future of UTI management lies in ongoing research, exploring personalized medicine, novel therapies, and innovative prevention strategies. By implementing these strategies and advancing research, healthcare providers can improve graft and patient survival, enhancing the quality of care for renal transplant recipients.
Collapse
Affiliation(s)
- Vidhi Bharuka
- Pediatrics, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Revat Meshram
- Pediatrics, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Pratiksha K Munjewar
- Medical Surgical Nursing, Smt. Radhikabai Meghe Memorial College of Nursing, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| |
Collapse
|
3
|
Medina I, Carpio C, Ruiz-Camps I, Albasanz-Puig A, Lopez-Godino O, Esperalba J, Beas F, Sanchez-Salinas M, Iacoboni G, Barba P. Adenovirus-induced hemorrhagic cystitis after CD19-targeted chimeric antigen receptor T-cell therapy in a patient with large B-cell lymphoma. Immunotherapy 2023; 15:1369-1374. [PMID: 37718888 DOI: 10.2217/imt-2023-0111] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/19/2023] Open
Abstract
Chimeric antigen receptor (CAR) T cells targeting CD19 have changed the treatment landscape of patients with relapsed/refractory diffuse large B-cell lymphoma. Infections are one of the most frequent complications after CAR T-cell therapy. Most of these infections are bacterial, although viral infections can also occur in this setting. Adenovirus-induced hemorrhagic cystitis is a rare infectious complication and is usually observed after bone marrow or solid organ transplantation. Herein we report a case of adenovirus-induced hemorrhagic cystitis in a patient experiencing urinary symptoms within the first month after CAR T-cell infusion. Based on our experience and a literature review, we discuss the diagnostic approach and potential treatment options for this infrequent infection after CAR T-cell therapy.
Collapse
Affiliation(s)
- Irene Medina
- Department of Hematology, Experimental Hematology, Vall d'Hebron Institute of Oncology, University Hospital Vall d'Hebron, 08035, Barcelona, Spain
| | - Cecilia Carpio
- Department of Hematology, Experimental Hematology, Vall d'Hebron Institute of Oncology, University Hospital Vall d'Hebron, 08035, Barcelona, Spain
- Department of Medicine, Universitat Autònoma de Barcelona, 08193, Bellaterra, Spain
| | - Isabel Ruiz-Camps
- Department of Medicine, Universitat Autònoma de Barcelona, 08193, Bellaterra, Spain
- Department of Infectious Diseases, Vall d'Hebron Research Institute, University Hospital Vall d'Hebron, 08035, Barcelona, Spain
| | - Adaia Albasanz-Puig
- Department of Medicine, Universitat Autònoma de Barcelona, 08193, Bellaterra, Spain
- Department of Infectious Diseases, Vall d'Hebron Research Institute, University Hospital Vall d'Hebron, 08035, Barcelona, Spain
| | - Oriana Lopez-Godino
- Department of Hematology, Hospital Universitario Morales Meseguer, 30008, Murcia, Spain
| | - Juliana Esperalba
- Department of Microbiology, University Hospital Vall d'Hebron, 08035, Barcelona, Spain
| | - Francisco Beas
- Department of Hematology, Experimental Hematology, Vall d'Hebron Institute of Oncology, University Hospital Vall d'Hebron, 08035, Barcelona, Spain
| | - Mario Sanchez-Salinas
- Department of Hematology, Experimental Hematology, Vall d'Hebron Institute of Oncology, University Hospital Vall d'Hebron, 08035, Barcelona, Spain
- Department of Medicine, Universitat Autònoma de Barcelona, 08193, Bellaterra, Spain
| | - Gloria Iacoboni
- Department of Hematology, Experimental Hematology, Vall d'Hebron Institute of Oncology, University Hospital Vall d'Hebron, 08035, Barcelona, Spain
- Department of Medicine, Universitat Autònoma de Barcelona, 08193, Bellaterra, Spain
| | - Pere Barba
- Department of Hematology, Experimental Hematology, Vall d'Hebron Institute of Oncology, University Hospital Vall d'Hebron, 08035, Barcelona, Spain
- Department of Medicine, Universitat Autònoma de Barcelona, 08193, Bellaterra, Spain
| |
Collapse
|
4
|
Oliver-Caldes A, Jiménez R, Español-Rego M, Cibeira MT, Ortiz-Maldonado V, Quintana LF, Castillo P, Guijarro F, Tovar N, Montoro M, Benitez-Ribas D, Bataller A, González-Navarro EA, Cid J, Lozano M, Perez-Amill L, Martin-Antonio B, Mena MP, Moreno DF, Rodríguez-Lobato LG, Campistol JM, Calvo G, Bladé J, Rosiñol L, Juan M, Pascal M, Urbano-Ispizua A, Fernández de Larrea C. First report of CART treatment in AL amyloidosis and relapsed/refractory multiple myeloma. J Immunother Cancer 2021; 9:jitc-2021-003783. [PMID: 34876408 PMCID: PMC8655576 DOI: 10.1136/jitc-2021-003783] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/14/2021] [Indexed: 12/01/2022] Open
Abstract
Multiple myeloma (MM) remains incurable despite the number of novel therapies that have become available in recent years. Occasionally, a patient with MM will develop an amyloid light-chain (AL) amyloidosis with organ dysfunction. Chimeric antigen receptor T-cell (CART) therapy has become a promising approach in treating hematological malignancies. Our institution has developed a second-generation B-cell maturation antigen (BCMA)–CART which is currently being tested in a clinical trial for relapsed/refractory MM. We present the first reported case, to our knowledge, of a patient with AL amyloidosis and renal involvement in the course of an MM, successfully treated with CART therapy targeting BCMA. The patient received a fractioned dose of 3×106/kg BCMA–CARTs after lymphodepletion. At 3 months from infusion, the patient had already obtained a deep hematological response with negative measurable residual disease by flow cytometry in the bone marrow. After 12 months, the patient remains in hematological stringent complete remission and has achieved an organ renal response with a decrease of 70% of proteinuria. This case suggests that concomitant AL amyloidosis in the setting of MM can benefit from CART therapy, even in patients in which predominant symptoms at the time of treating are caused by AL amyloidosis.
Collapse
Affiliation(s)
- Aina Oliver-Caldes
- Hematology Department, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clinic de Barcelona, Barcelona, Spain.,Amyloidosis and Multiple Myeloma Unit, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Raquel Jiménez
- Hematology Department, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clinic de Barcelona, Barcelona, Spain.,Amyloidosis and Multiple Myeloma Unit, Hospital Clinic de Barcelona, Barcelona, Spain.,Clinical Trial Unit, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Marta Español-Rego
- Immunology Department, Hospital Clinic de Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clinic de Barcelona, Barcelona, Spain
| | - Maria Teresa Cibeira
- Hematology Department, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clinic de Barcelona, Barcelona, Spain.,Amyloidosis and Multiple Myeloma Unit, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Valentín Ortiz-Maldonado
- Hematology Department, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clinic de Barcelona, Barcelona, Spain
| | - Luis F Quintana
- Amyloidosis and Multiple Myeloma Unit, Hospital Clinic de Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clinic de Barcelona, Barcelona, Spain.,Glomerular Disease Unit (CSUR), Nephrology Department, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Paola Castillo
- Amyloidosis and Multiple Myeloma Unit, Hospital Clinic de Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clinic de Barcelona, Barcelona, Spain.,Pathology Department, Hospital Clinic de Barcelona, Barcelona, Spain
| | | | - Natalia Tovar
- Hematology Department, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clinic de Barcelona, Barcelona, Spain.,Amyloidosis and Multiple Myeloma Unit, Hospital Clinic de Barcelona, Barcelona, Spain.,Clinical Trial Unit, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Mercedes Montoro
- Hematology Department, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clinic de Barcelona, Barcelona, Spain
| | - Daniel Benitez-Ribas
- Immunology Department, Hospital Clinic de Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clinic de Barcelona, Barcelona, Spain
| | - Alex Bataller
- Hematology Department, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clinic de Barcelona, Barcelona, Spain
| | - E Azucena González-Navarro
- Immunology Department, Hospital Clinic de Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clinic de Barcelona, Barcelona, Spain
| | - Joan Cid
- Apheresis Unit, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Miquel Lozano
- Apheresis Unit, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Lorena Perez-Amill
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clinic de Barcelona, Barcelona, Spain
| | | | - Mari-Pau Mena
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clinic de Barcelona, Barcelona, Spain
| | - David F Moreno
- Hematology Department, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clinic de Barcelona, Barcelona, Spain.,Amyloidosis and Multiple Myeloma Unit, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Luis Gerardo Rodríguez-Lobato
- Hematology Department, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clinic de Barcelona, Barcelona, Spain.,Amyloidosis and Multiple Myeloma Unit, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Josep Maria Campistol
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clinic de Barcelona, Barcelona, Spain.,Glomerular Disease Unit (CSUR), Nephrology Department, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Gonzalo Calvo
- Clinical Pharmacology Department, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Joan Bladé
- Hematology Department, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clinic de Barcelona, Barcelona, Spain.,Amyloidosis and Multiple Myeloma Unit, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Laura Rosiñol
- Hematology Department, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clinic de Barcelona, Barcelona, Spain.,Amyloidosis and Multiple Myeloma Unit, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Manel Juan
- Immunology Department, Hospital Clinic de Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clinic de Barcelona, Barcelona, Spain
| | - Mariona Pascal
- Immunology Department, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Alvaro Urbano-Ispizua
- Hematology Department, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clinic de Barcelona, Barcelona, Spain
| | - Carlos Fernández de Larrea
- Hematology Department, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clinic de Barcelona, Barcelona, Spain .,Amyloidosis and Multiple Myeloma Unit, Hospital Clinic de Barcelona, Barcelona, Spain
| |
Collapse
|