Recommendations for screening, monitoring, prevention, and prophylaxis of infections in adult and pediatric patients receiving CAR T-cell therapy: a position paper

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;...

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Detalles Bibliográficos
Autores: 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
Tipo de recurso: artículo
Estado:Versión publicada
Fecha de publicación:2021
País:España
Institución:INCLIVA
Repositorio:r-INCLIVA. Repositorio Institucional de Producción Científica de INCLIVA
OAI Identifier:oai:incliva.fundanetsuite.com:p15153
Acceso en línea:https://incliva.portalinvestigacion.com/publicaciones/15153
Access Level:acceso abierto
Palabra clave:B-cell acute lymphoblastic leukemia
Bacterial infections
Chimeric antigen receptor
Diffuse large B-cell lymphoma
Fungal infections
Viral infections
Descripción
Sumario: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.

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