Recommendations for screening, monitoring, prevention, and prophylaxis of infections in adult and pediatric patients receiving CAR T-cell therapy: a position paper
Por:
Los-Arcos, I, Iacoboni, G, Aguilar-Guisado, M, Alsina-Manrique, L, de Heredia, CD, Fortuny-Guasch, C, Garcia-Cadenas, I, Garcia-Vidal, C, Gonzalez-Vicent, M, Hernani, R, Kwon, M, Machado, M, Martinez-Gomez, X, Maldonado, VO, Pla, CP, Pinana, JL, Pomar, V, Reguera-Ortega, JL, Salavert, M, Soler-Palacin, P, Vazquez-Lopez, L, Barba, P, Ruiz-Camps, I
Publicada:
1 abr 2021
Ahead of Print:
1 sep 2020
Resumen:
Chimeric antigen receptor (CAR) T-cell therapy is one of the most promising emerging treatments for B-cell malignancies. Recently, two CAR T-cell products (axicabtagene ciloleucel and tisagenlecleucel) have been approved for patients with aggressive B-cell lymphoma and acute lymphoblastic leukemia; many other CAR-T constructs are in research for both hematological and non-hematological diseases. Most of the patients receiving CAR-T therapy will develop fever at some point after infusion, mainly due to cytokine release syndrome (CRS). The onset of CRS is often indistinguishable from an infection, which makes management of these patients challenging. In addition to the lymphodepleting chemotherapy and CAR T cells, the treatment of complications with corticosteroids and/or tocilizumab increases the risk of infection in these patients. Data regarding incidence, risk factors and prevention of infections in patients receiving CAR-T cell therapy are scarce. To assist in patient care, a multidisciplinary team from hospitals designated by the Spanish Ministry of Health to perform CAR-T therapy prepared these recommendations. We reviewed the literature on the incidence, risk factors, and management of infections in adult and pediatric patients receiving CAR-T cell treatment. Recommendations cover different areas: monitoring and treatment of hypogammaglobulinemia, prevention, prophylaxis, and management of bacterial, viral, and fungal infections as well as vaccination prior and after CAR-T cell therapy.
Filiaciones:
Los-Arcos, I:
Hosp Univ Vall DHebron, Infect Dis Dept, Barcelona, Spain
Univ Autonoma Barcelona, Dept Med, Barcelona, Spain
Iacoboni, G:
Hosp Univ Vall DHebron, Vall DHebron Inst Oncol VHIO, Dept Hematol, Barcelona, Spain
Aguilar-Guisado, M:
Univ Hosp Virgen Rocio, Dept Infect Dis Microbiol & Prevent Med, Inst Biomed Seville IBIS, CSIC, Seville, Spain
Alsina-Manrique, L:
Hosp St Joan Deu, Clin Immunol & Primary Immunodeficiencies Unit, Barcelona, Spain
de Heredia, CD:
Hosp Univ Vall DHebron, Paediat Oncol & Hematol Dept, Hematopoiet Stem Cell Transplantat, Barcelona, Spain
Fortuny-Guasch, C:
Hosp St Joan Deu, Infect Dis Unit, Barcelona, Spain
Garcia-Cadenas, I:
Autonomous Univ Barcelona, Hosp Santa Creu & St Pau, Hematol Dept, St Pau Res Inst, Barcelona, Spain
Autonomous Univ Barcelona, Hosp Santa Creu & St Pau, Hematol Dept, Jose Carreras Leukemia Res Inst, Barcelona, Spain
Garcia-Vidal, C:
Univ Barcelona, IDIBAPS Inst Invest Biomed Agust Pi & Sunyer, Hosp Clin, Dept Infect Dis, Barcelona, Spain
Gonzalez-Vicent, M:
Hosp Infantil Univ Nino Jesus, Hematopoiet Stem Cell Transplantat & Cellular The, Madrid, Spain
Hernani, R:
Hosp Clin Univ, Inst Res INCLIVA, Dept Hematol, Valencia, Spain
Kwon, M:
Hosp Gen Univ Gregorio Maranon, Gregorio Maranon Hlth Res Inst, Haematol & Haemotherapy Dept, Madrid, Spain
Machado, M:
Hosp Gen Univ Gregorio Maranon, Gregorio Maranon Hlth Res Inst, Clin Microbiol & Infect Dis, Madrid, Spain
Martinez-Gomez, X:
Univ Autonoma Barcelona, Vall DHebron Univ Hosp, Epidemiol Dept, Barcelona, Spain
Maldonado, VO:
Univ Barcelona, Inst Invest Biomed August Pi & Sunyer IDIBAPS, Hosp Clin Barcelona, Dept Hematol, Barcelona, Spain
Univ Barcelona, Ctr Invest Biomed Red Canc CIBERONC, Barcelona, Spain
Pla, CP:
Hosp Clin Univ, Inst Invest INCLIVA, Infect Dis Unit, Valencia, Spain
Pinana, JL:
Inst Carlos III, Hosp Univ & Politecn La Fe, Inst Invest Sanitaria La Fe, Hematol Div,CIBERONC, Madrid, Spain
Pomar, V:
Hosp Santa Creu & Sant Pau, Internal Med Dept, Infect Dis Unit, Barcelona, Spain
Reguera-Ortega, JL:
Univ Hosp Virgen Rocio, Inst Biomed Seville IBIS, Dept Haematol, CSIC, Seville, Spain
Salavert, M:
Hosp Univ & Politecn La Fe, Area Clin Med, Infect Dis Unit, Valencia, Spain
Soler-Palacin, P:
Hosp Univ Vall DHebron, Pediat Infect Dis & Immunodeficiencies Unit, Barcelona, Spain
Vazquez-Lopez, L:
Univ Hosp Salamanca, Dept Haematol, Salamanca, Spain
Barba, P:
Hosp Univ Vall DHebron, Vall DHebron Inst Oncol VHIO, Dept Hematol, Barcelona, Spain
Univ Autonoma Barcelona, Dept Med, Passeig Vall dHebron 119-129, Barcelona 08035, Spain
Ruiz-Camps, I:
Hosp Univ Vall DHebron, Infect Dis Dept, Barcelona, Spain
Univ Autonoma Barcelona, Dept Med, Barcelona, Spain
Green Published, Bronze
|