Old Pathogens-New Patient Types: Infections in a CAR T-Cell Recipient. Could It Get Any More Complicated?

IF 2.6 4区医学 Q3 IMMUNOLOGY

Transplant Infectious Disease Pub Date : 2025-08-21 DOI:10.1111/tid.70093

Monica Melchio, Joshua A Hill, Maunank Shah, Dionysios Neofytos, Massimiliano Gambella, Anna Maria Raiola, Emanuele Delfino, Elisa Balletto, Emanuele Angelucci, Matteo Bassetti, Malgorzata Mikulska

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引用次数: 0

Abstract

The case discussed involves a 41-year-old Italian man who was a candidate for chimeric antigen receptor T-cell therapy (CAR-T) for mediastinal diffuse large B-cell lymphoma. His CAR-T treatment was postponed several times due to prolonged relapsing COVID-19 and new onset of pulmonary Mycobacterium tuberculosis diseases. After 11 weeks of antimycobacterial treatment, CAR T-cell therapy was performed, but complicated by cytokine release syndrome (CRS) and immune effector cell-associated neurotoxicity syndrome (ICANS). Two months after CAR-T, the patient developed invasive pulmonary aspergillosis due to A. fumigatus. He was successfully treated with a 6-month course of antitubercular therapy and an 8-month course of antifungal therapy with isavuconazole. Lobectomy was performed due to episodes of severe hemoptysis. The challenging issues of diagnosis, choice, and management of treatments, including drug-drug interactions and length of therapy, are discussed.

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旧病原体-新患者类型：CAR - t细胞受体感染。事情还会变得更复杂吗？

所讨论的病例涉及一名41岁的意大利男性，他是接受嵌合抗原受体t细胞疗法（CAR-T）治疗纵隔弥漫性大b细胞淋巴瘤的候选人。他的CAR-T治疗因COVID-19长期复发和肺部结核分枝杆菌疾病的新发而多次推迟。抗真菌治疗11周后，进行CAR - t细胞治疗，但合并细胞因子释放综合征（CRS）和免疫效应细胞相关神经毒性综合征（ICANS）。CAR-T治疗两个月后，患者因烟曲霉感染出现侵袭性肺曲霉病。他成功地接受了6个月的抗结核治疗和8个月的异戊康唑抗真菌治疗。因严重咯血发作而行肺叶切除术。具有挑战性的问题的诊断，选择和管理的治疗，包括药物-药物相互作用和治疗的长度，进行了讨论。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Transplant Infectious Disease 医学-传染病学

CiteScore

5.30

自引率

7.70%

发文量

210

审稿时长

4-8 weeks

期刊介绍： Transplant Infectious Disease has been established as a forum for presenting the most current information on the prevention and treatment of infection complicating organ and bone marrow transplantation. The point of view of the journal is that infection and allograft rejection (or graft-versus-host disease) are closely intertwined, and that advances in one area will have immediate consequences on the other. The interaction of the transplant recipient with potential microbial invaders, the impact of immunosuppressive strategies on this interaction, and the effects of cytokines, growth factors, and chemokines liberated during the course of infections, rejection, or graft-versus-host disease are central to the interests and mission of this journal. Transplant Infectious Disease is aimed at disseminating the latest information relevant to the infectious disease complications of transplantation to clinicians and scientists involved in bone marrow, kidney, liver, heart, lung, intestinal, and pancreatic transplantation. The infectious disease consequences and concerns regarding innovative transplant strategies, from novel immunosuppressive agents to xenotransplantation, are very much a concern of this journal. In addition, this journal feels a particular responsibility to inform primary care practitioners in the community, who increasingly are sharing the responsibility for the care of these patients, of the special considerations regarding the prevention and treatment of infection in transplant recipients. As exemplified by the international editorial board, articles are sought throughout the world that address both general issues and those of a more restricted geographic import.