Transplantation and Cellular Therapy最新文献

{"title":"Masthead (Purpose and Scope)","authors":"","doi":"10.1016/S2666-6367(26)00733-5","DOIUrl":"10.1016/S2666-6367(26)00733-5","url":null,"abstract":"","PeriodicalId":23283,"journal":{"name":"Transplantation and Cellular Therapy","volume":"32 10","pages":"Pages A1-A2"},"PeriodicalIF":4.7,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149124627","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Austrian Real-world Experience With Standard of Care Brexucabtagene Autoleucel in Patients With Relapsed or Refractory Mantle-Cell Lymphoma","authors":"Stefan Koeck,&nbsp;Natalia Rotter,&nbsp;Olga Stiefel,&nbsp;Michael Leisch,&nbsp;Nina Worel,&nbsp;Stephanie Winter,&nbsp;Kathrin Philipp-Abbrederis,&nbsp;Normann Steiner,&nbsp;Petra Pichler,&nbsp;Bernhard Fössl,&nbsp;Bianca Huber-Kraßnitzer,&nbsp;Christoph Grabmer,&nbsp;Orkan Kartal,&nbsp;Bernd Schöpf,&nbsp;Georg Heß,&nbsp;Linda Simon,&nbsp;Philipp Wohlfarth,&nbsp;Jakob Rudzki,&nbsp;Markus Raderer,&nbsp;Thomas Melchardt","doi":"10.1016/j.jtct.2026.04.019","DOIUrl":"10.1016/j.jtct.2026.04.019","url":null,"abstract":"<div><div>Mantle-cell lymphoma (MCL) represents a rare B cell malignancy with a challenging treatment situation in the case of relapsed or refractory (r/r) disease. Brexu-cel as first approved chimeric antigen receptor T cell (CART) therapy revolutionized the therapeutic landscape and outcome in r/r MCL patients. This retrospective study analyzes the real-world data of patients with r/r MCL enrolled into the CART program in Austria. In total, 33 patients in Austria were analyzed from 2021 to January 2025. Inclusion criteria comprised confirmed diagnosis of r/r MCL, an age ≥18 years and a confirmed enrollment into the CART program. Primary endpoints were the overall response rate (ORR), overall survival (OS) and progression-free survival (PFS). Further endpoints included the incidence and severity of CART-specific adverse events (AE) such as the cytokine-release-syndrome (CRS) and the immune effector cell-associated neurotoxicity syndrome (ICANS). Of all 33 patients enrolled into the CART program, 24 patients (72.7%) were treated with brexu-cel whereas 9 patients (27.3%) received alternative treatments. Most common cause for alternative treatment was disease progression. The ORR for brexu-cel was 95.9%, with a 2-year OS- and PFS rate of 76.8% and 50.8%, respectively. In the alternative treatment group, the 2-year OS and PFS rates were 13.9% and 18.5%. Grade ≥2 CRS and ICANS occurred in 62.5% and 37.5%, respectively. There were no Grade 5 adverse events related to brexu-cel. Patients with a leukocyte count &gt;4.1 G/L at the time point of lymphodepletion had a significantly higher incidence of CRS grade ≥2, whereas a neutrophil count ≥4.75 G/L at the time point of lymphodepletion was associated with a higher incidence of ICANS grade ≥2. Our study provides first insights into the real-world trajectories and outcomes of r/r MCL patients intended for brexu-cel treatment in Austria. This analysis confirms the high rates of ORR and OS of Brexu-cel in MCL also in the real-world setting. Exploratory analysis suggested that increased leukocyte and neutrophil counts at lymphodepletion may be associated with increased risk of CRS and ICANS, respectively.</div></div>","PeriodicalId":23283,"journal":{"name":"Transplantation and Cellular Therapy","volume":"32 10","pages":"Pages 1250.e1-1250.e11"},"PeriodicalIF":4.7,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147723794","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Phase 1b Study of Efmarodocokin Alfa, an Interleukin-22 Agonist, in Combination with Standard of Care, in Patients Undergoing Allogeneic Hematopoietic Stem Cell Transplantation","authors":"Shukaib Arslan,&nbsp;Corey Cutler,&nbsp;Amin Alousi,&nbsp;Mehdi Hamadani,&nbsp;Sunil H. Abhyankar,&nbsp;Iskra Pusic,&nbsp;Maureen Ross,&nbsp;Gary Schiller,&nbsp;Ajit Dash,&nbsp;Wenyi Liu,&nbsp;Yanke Yu,&nbsp;Annemarie Lekkerkerker,&nbsp;Chin Wong,&nbsp;Melicent C. Peck","doi":"10.1016/j.jtct.2026.05.042","DOIUrl":"10.1016/j.jtct.2026.05.042","url":null,"abstract":"<div><div>Acute graft-versus-host disease (aGVHD) remains a serious complication of allogeneic hematopoietic stem cell transplantation (HSCT), and no nonimmunosuppressive pharmacologic therapies are currently available for prophylaxis. We conducted a Phase 1b, open-label, dose-escalation study to evaluate the safety, pharmacokinetics (PK), and preliminary activity of efmarodocokin alfa, an interleukin-22 agonist, administered with standard-of-care prophylaxis in patients undergoing matched unrelated and matched related donor allogeneic HSCT following myeloablative conditioning. Eighteen patients were enrolled across 3 dose cohorts receiving efmarodocokin alfa at 30 µg/kg every 4 weeks, 30 µg/kg every 2 weeks, or 60 µg/kg every 2 weeks. Efmarodocokin alfa was well-tolerated and demonstrated an acceptable safety and PK profile, characterized by predominantly Grades 1 to 2 adverse events and linear PK across all dose levels. All patients achieved neutrophil engraftment by Day 30. By Day 100 post-transplant, 5 patients (27.8%) developed Grade 2 aGVHD, 2 (11.1%) of which had Stage 1 lower GI aGVHD. No patients developed Grades 3 to 4 aGVHD. Exploratory analysis demonstrated a lower gastrointestinal aGVHD-free survival rate of 83.3% at Day 180 and overall survival of 77.8% at Day 365. Although conclusions regarding efficacy are limited by the small sample size and exploratory design, these results demonstrate favorable safety and PK characteristics and provide initial observations regarding the potential role of efmarodocokin alfa in the prevention of lower gastrointestinal aGVHD as a nonimmunosuppressive prophylactic strategy.</div></div>","PeriodicalId":23283,"journal":{"name":"Transplantation and Cellular Therapy","volume":"32 10","pages":"Pages 1248.e1-1248.e14"},"PeriodicalIF":4.7,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148144883","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Valganciclovir for CMV Prophylaxis After PTCy-Based Allogeneic Hematopoietic Cell Transplantation","authors":"Nermen Tawfik,&nbsp;Ashleigh P. Scott,&nbsp;Catelyn Cashion,&nbsp;James Schwarer,&nbsp;Matthew J. Gleeson,&nbsp;Joanne L. Tan,&nbsp;Michael Ashby,&nbsp;John Coutsouvelis,&nbsp;Shevon Fernando,&nbsp;Louis Do,&nbsp;Bianca Cirone,&nbsp;Shu M. Wong,&nbsp;Sushrut S. Patil,&nbsp;Shafqat Inam,&nbsp;Bradley J. Gardiner,&nbsp;Shaun A. Fleming,&nbsp;Andrew P. Grigg,&nbsp;Andrew Spencer,&nbsp;David J. Gottlieb,&nbsp;Catherine Orla Morrissey,&nbsp;David J. Curtis","doi":"10.1016/j.jtct.2026.06.006","DOIUrl":"10.1016/j.jtct.2026.06.006","url":null,"abstract":"&lt;div&gt;&lt;div&gt;Cytomegalovirus (CMV) reactivation is a serious complication after allogeneic hematopoietic cell transplantation (alloHCT), with heightened risk in recipients receiving post-transplant cyclophosphamide (PTCy)-based prophylaxis. Although letermovir reduces clinically significant CMV infection (csCMVi), its prohibitive cost limits access, highlighting the need for affordable alternatives. Unlike solid organ transplantation, there are no published studies reporting the utility of valganciclovir for CMV prophylaxis following PTCy-based alloHCT. The aim of this study was to evaluate the deliverability and efficacy of valganciclovir for CMV prophylaxis in adults undergoing alloHCT using PTCy-based graft-versus-host disease (GVHD) prophylaxis. We conducted a retrospective study screening 244 consecutive adults undergoing alloHCT at a single center (January 1, 2020 to October 31, 2024). Inclusion criteria were CMV-seropositive recipients receiving PTCy-based GVHD prophylaxis and intended for valganciclovir prophylaxis (900 mg daily) commencing after engraftment (neutrophils &gt;1.0 × 10&lt;sup&gt;9&lt;/sup&gt;/L and platelets &gt;20 × 10&lt;sup&gt;9&lt;/sup&gt;/L without platelet transfusion) and planned until day +100. For comparison with a pre-emptive strategy, outcomes were compared with a contemporaneous cohort of CMV-seropositive haploidentical transplant recipients from 2 additional Australian transplant centers. All patients underwent weekly quantitative CMV PCR monitoring from day 0 to day +100, and thereafter as clinically indicated. Primary endpoints were deliverability and csCMVi at day +100. Of the 244 screened patients, 124 (69 matched donor and 55 haploidentical donor alloHCT) met the inclusion criteria. Overall, 86 patients (69%) initiated valganciclovir prophylaxis, with a median time to commencement of 26 days post-transplant (IQR 21-34). The primary reason for noninitiation was inadequate hematopoietic recovery (31%). Prophylaxis initiation was significantly less frequent following haploidentical versus matched donor alloHCT (31/55 [56%] vs 55/69 [80%]; &lt;em&gt;P&lt;/em&gt; = .005). The cumulative incidence of csCMVi in recipients commencing prophylaxis was 13% (95% CI, 7-21) compared with 63% (95% CI, 45-76) in those not commencing prophylaxis (HR .11; 95% CI, .05-.24; &lt;em&gt;P&lt;/em&gt; &lt; .0001). Among patients commencing prophylaxis, 13% experienced breakthrough csCMVi requiring escalation to therapeutic dose antiviral therapy after a median of 15 days of prophylaxis. In multivariable analysis, prophylaxis initiation was independently associated with a markedly reduced csCMVi risk (adjusted hazard ratio [aHR] .09; 95% CI, .04-.20; &lt;em&gt;P&lt;/em&gt; &lt; .001). Haploidentical donor alloHCT independently increased csCMVi risk 4.5-fold in landmark analysis. Comparison with a contemporaneous cohort of 119 haploidentical recipients managed with pre-emptive CMV therapy confirmed the benefit of prophylaxis (aHR .18; 95% CI, .08-.42; &lt;em&gt;P&lt;/em&gt; &lt; .001). Late csCMVi followin","PeriodicalId":23283,"journal":{"name":"Transplantation and Cellular Therapy","volume":"32 10","pages":"Pages 1311.e1-1311.e12"},"PeriodicalIF":4.7,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148195114","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Monospecific and Bispecific Chimeric Antigen Receptor (CAR) T-cell Therapy in Multiple Myeloma: A Systematic Review, Meta-analysis and Meta-regression","authors":"Ainsley Ryan Yan Bin Lee,&nbsp;Hon Jen Wong,&nbsp;Chi Ching Lim,&nbsp;Sanjay De Mel,&nbsp;Melissa Ooi,&nbsp;Wee Joo Chng,&nbsp;Yu Yang Soon,&nbsp;Cinnie Yentia Soekojo","doi":"10.1016/j.jtct.2026.06.001","DOIUrl":"10.1016/j.jtct.2026.06.001","url":null,"abstract":"&lt;div&gt;&lt;div&gt;Chimeric antigen receptor (CAR) T-cell therapy has revolutionized treatment for relapsed/refractory multiple myeloma (RRMM). However, comparative effectiveness across CAR products, target antigens, and patient subgroups remains incompletely characterized. Particularly, with the emergence of G protein-coupled receptor family C group 5 member D (GPRC5D)-directed, bispecific, and dual-target strategies, efficacy in patients who have relapsed/refractory disease after anti-B cell maturation antigen (BCMA) therapy has not been studied in detail. We systematically searched 5 electronic databases from January 1, 2010 to December 5, 2025. Eligible studies reported clinical outcomes of CAR T-cell therapy in MM. Primary efficacy endpoints included overall response (ORR) and complete response (CR) rate. Safety endpoints included hematologic and immunologic toxicities. Random-effects meta-analyses were performed using R, with prespecified subgroup and meta-regression analyses according to demographic, disease and treatment-related factors such as antigen target, CAR construct, prior treatment burden, extramedullary disease and high-risk cytogenetics. Of 52 reports of 44 cohorts (2 frontline and 42 relapsed/refractory cohorts) including 1833 patients were analyzed. Across all CAR T-cell platforms, the pooled ORR was 88% (95% confidence interval [CI]: 83 to 91) and CR rate was 55% (95% CI: 47 to 62). For autologous BCMA-directed CAR T-cell therapy, ORR was 89% (95% CI: 82 to 93) and CR rate was 57% (95% CI: 47 to 66), whereas allogeneic BCMA CAR-T had a lower ORR of 58% (95% CI: 1 to 100) and CR rate of 21% (95% CI: 6 to 51). Bispecific and dual-target strategies demonstrated encouraging activity with BCMA/CD19-directed CAR T-cells achieving an ORR of 92% (95% CI: 89 to 95) and CR rate of 64% (95% CI: 16 to 94), while BCMA/CD38-directed CAR T-cells achieved an ORR of 88% (95% CI: 82 to 93) and CR rate of 61% (95% CI: 22 to 90). For GPRC5D-directed CAR T-cell therapy, ORR was 89% (95% CI: 84 to 92) and CR rate was 50% (95% CI: 32 to 69). Among BCMA-relapsed/refractory patients, subsequent GPRC5D-directed CAR T-cell therapy achieved an ORR of 82% (95% CI: 66 to 91) and CR rate of 35%. MRD negativity was observed in 78% (95% CI: 68 to 86) of evaluable patients overall. Subgroup analyses demonstrated significantly lower ORR and CR in cohorts with higher extramedullary disease. Grade ≥3 hematologic toxicities were frequent: neutropenia occurred in 83% (95% CI: 76 to 89), leukopenia in 73% (95% CI: 59 to 83), anemia in 46% (95% CI: 38 to 54), and thrombocytopenia in 48% (95% CI: 41 to 56). Grade ≥3 cytokine release syndrome occurred in 8% (95% CI: 6 to 11), while grade ≥3 immune effector cell-associated neurotoxicity syndrome occurred in 3% (95% CI: 2 to 5). CAR T-cell therapy produces high response rates, substantial depth of remission, and frequent MRD negativity in multiple myeloma, including heavily pretreated RRMM. Antigen switching strategies after an","PeriodicalId":23283,"journal":{"name":"Transplantation and Cellular Therapy","volume":"32 10","pages":"Pages 1223-1238"},"PeriodicalIF":4.7,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148212663","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Randomized Trial of Two Fractionation Schedules of Myeloablative Busulfan with Fludarabine and Cladribine in Acute Myeloid Leukemia or Myelodysplastic Syndromes","authors":"Uday R. Popat,&nbsp;Konstantinos Lontos,&nbsp;Roland Bassett,&nbsp;Jitesh Kawedia,&nbsp;Ben C. Valdez,&nbsp;Alison M. Gulbis,&nbsp;Amin M. Alousi,&nbsp;Gheath Al-Atrash,&nbsp;Qaiser Bashir,&nbsp;Chitra M. Hosing,&nbsp;Jin S. Im,&nbsp;Partow Kebriaei,&nbsp;Issa Khouri,&nbsp;David Marin,&nbsp;Rohtesh S. Mehta,&nbsp;Yago Nieto,&nbsp;Betul Oran,&nbsp;Amanda Olson,&nbsp;Muzaffar H. Qazilbash,&nbsp;Jeremy Ramdial,&nbsp;Elizabeth J. Shpall","doi":"10.1016/j.jtct.2026.06.014","DOIUrl":"10.1016/j.jtct.2026.06.014","url":null,"abstract":"<div><h3>Background</h3><div>A myeloablative busulfan (Bu) and fludarabine (Flu) regimen that includes fractionating Bu and extending its delivery time results in low toxicity, permitting its use in stem cell transplantation recipients who otherwise would receive reduced-intensity conditioning. Cladribine (Clad) is an active agent in acute myeloid leukemia (AML) that may synergize with Flu. This phase 2 randomized trial examined whether additional Bu fractionation improved the efficacy and safety of a Clad- and Flu-containing regimen.</div></div><div><h3>Study Design</h3><div>Patients with AML or myelodysplastic syndrome (MDS) age 18 to 70 years with a matched donor were randomized to 2 arms. Patients in arm A received outpatient Bu 80 mg/m² on days -13 and -12, while those in arm B received outpatient Bu 80 mg/m² on days -20 and -13. Both groups also received Flu 10 mg/m², Clad 10 mg/m², and Bu pharmacokinetically dosed for a total exposure of 20,000 ± 12% µmol·minute on days -6 to -3. The primary outcome was progression-free survival (PFS).</div></div><div><h3>Results</h3><div>A total of 116 patients were randomized, including 59 to arm A and 57 to arm B. The 3-year PFS was 48.7% (95% confidence interval [CI], 37.4% to 63.4%) in arm A and 61.3% (95% CI, 49.9% to 75.4%) in arm B (<em>P</em> = .19). The rate of grade ≥3 toxicities was higher in arm A compared with arm B (93.2% versus 73.7%; <em>P</em> = .005). Three-year nonrelapse mortality in the 2 groups was 19% (95% CI, 8.7% to 29.2%) and 7% (95% CI, 0.3% to 13.7%) (<em>P</em> = .066), and the 3-year relapse rate was 32.3% (95% CI, 20.2% to 44.4%) and 31.7% (95% CI, 19.4% to 43.9%) (<em>P</em> = .99). A multivariate Bayesian regression analysis supported an overall survival and PFS benefit in the longer-duration arm B.</div></div><div><h3>Conclusions</h3><div>This Bu, Flu, and Clad regimen with 3 weeks of busulfan fractionation appears to be safe and effective. Furthermore, fractionation of Bu with administration over a 3-week period reduces toxicity without increasing the relapse rate, allowing safe delivery of a myeloablative regimen to older patients.</div></div>","PeriodicalId":23283,"journal":{"name":"Transplantation and Cellular Therapy","volume":"32 10","pages":"Pages 1297.e1-1297.e12"},"PeriodicalIF":4.7,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148240394","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comment on “Increased Susceptibility to Long-Term Complications in Leukemia Survivors Who Received Hematopoietic Stem Cell Transplantation During Adolescence”","authors":"Madhuri Tribhuvan,&nbsp;Shashikant N. Phatke","doi":"10.1016/j.jtct.2026.06.004","DOIUrl":"10.1016/j.jtct.2026.06.004","url":null,"abstract":"","PeriodicalId":23283,"journal":{"name":"Transplantation and Cellular Therapy","volume":"32 10","pages":"Pages 1357.e1-1357.e2"},"PeriodicalIF":4.7,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148164712","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Officers and Directors of ASTCT","authors":"","doi":"10.1016/S2666-6367(26)00735-9","DOIUrl":"10.1016/S2666-6367(26)00735-9","url":null,"abstract":"","PeriodicalId":23283,"journal":{"name":"Transplantation and Cellular Therapy","volume":"32 10","pages":"Page A4"},"PeriodicalIF":4.7,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149125010","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk Factors and Outcomes of Pneumocystis jirovecii Pneumonia after Allogeneic Hematopoietic Stem Cell Transplantation for Hematological Malignancy: A 10-Yr Cohort Study","authors":"Qiusha Huang,&nbsp;Haoyue Cui,&nbsp;Xiaolu Zhu,&nbsp;Yun He,&nbsp;Haixia Fu,&nbsp;Yao Chen,&nbsp;Yuhong Chen,&nbsp;Chenhua Yan,&nbsp;Yuanyuan Zhang,&nbsp;Yifei Cheng,&nbsp;Fengrong Wang,&nbsp;Tingting Han,&nbsp;Yuqian Sun,&nbsp;Xiaodong Mo,&nbsp;Yu Wang,&nbsp;Yingjun Chang,&nbsp;Xiangyu Zhao,&nbsp;Lanping Xu,&nbsp;Xiaojun Huang,&nbsp;Xiaohui Zhang","doi":"10.1016/j.jtct.2026.03.033","DOIUrl":"10.1016/j.jtct.2026.03.033","url":null,"abstract":"<div><div><em>Pneumocystis jirovecii</em> pneumonia (PJP) is a life-threatening opportunistic infection that occurs after allogeneic hematopoietic stem cell transplantation (allo-HSCT). The risk factors and prognostic factors for PJP under current transplantation and monitoring practices are not well understood. In this retrospective cohort study, we aimed to characterize the clinical features, identify risk factors for its occurrence, and determine prognostic factors of PJP for survival. Between 2012 and 2022, 8596 patients underwent allo-HSCT at the Peking University Institute of Hematology. From this cohort, 88 patients with PJP were retrospectively identified, and after 16 patients were excluded because of incomplete data or loss to follow-up, 72 patients were included in the final analysis. We also conducted a nested case–control study to identify risk factors associated with PJP onset. For every patient diagnosed with PJP, three control subjects were randomly chosen and matched by transplant date within 90 d and follow-up duration within 180 d. Finally, 72 PJP patients and 216 controls without PJP were analyzed. In this study, the prevalence of PJP post allo-HSCT was 1.0% (88/8596). Patients who developed PJP had significantly lower 5-yr overall survival (OS) (58.7% versus 84.3%; <em>P</em> &lt; .001) and 5-yr disease-free survival (57.3% versus 82.0%; <em>P</em> &lt; .001) and higher 5-yr nonrelapse mortality (33.0% versus 8.5%; <em>P</em> &lt; .001) than the controls did. The median time from transplantation to PJP diagnosis was 10 mo, with 29.2% of cases occurring more than 1 yr post-HSCT. Multivariate analysis revealed that an age greater than 45 yr at transplantation, peak corticosteroid dose, and lower CD4⁺ T cell count were independent risk factors for developing PJP. Among patients with PJP, the presence of chronic graft-versus-host disease, coexisting EBV infection, anemia (hemoglobin &lt;100 g/L), and respiratory failure were independent predictors of poor OS. Our findings revealed that patients with PJP had a poor prognosis. These results suggest that the standard duration of prophylaxis may be insufficient for many patients, underscoring the need for individualized, risk-adapted strategies. Early identification of high-risk patients could guide prolonged prophylaxis and improve outcomes.</div></div>","PeriodicalId":23283,"journal":{"name":"Transplantation and Cellular Therapy","volume":"32 10","pages":"Pages 1309.e1-1309.e12"},"PeriodicalIF":4.7,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148273173","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of ASTCT Toxicity Grading System on Outcomes After CAR-T for Mature B-Cell Malignancies","authors":"Marina Gomez-Llobell,&nbsp;Silvia Escribano Serrat,&nbsp;Maria Bromberg,&nbsp;Venkatraman Seshan,&nbsp;Sean Devlin,&nbsp;Sigrun Einarsdottir,&nbsp;Ori Ben Valid,&nbsp;Noa Golan-Aceb,&nbsp;Ronit Marcus,&nbsp;Avichai Simoni,&nbsp;Ofrat Beyar-Katz,&nbsp;Shoshan Perek,&nbsp;Ali Abed Al Wahad,&nbsp;Magdalena Corona,&nbsp;Kai Rejeski,&nbsp;Sandeep S. Raj,&nbsp;Parastoo Dahi,&nbsp;Michael Scordo,&nbsp;Gunjan L. Shah,&nbsp;M. Lia Palomba,&nbsp;Miguel-Angel Perales","doi":"10.1016/j.jtct.2026.05.032","DOIUrl":"10.1016/j.jtct.2026.05.032","url":null,"abstract":"<div><div>The American Society for Transplantation and Cellular Therapy (ASTCT) consensus grading system standardized the classification of cytokine release syndrome (CRS) and immune effector cell-associated neurotoxicity syndrome (ICANS) after chimeric antigen receptor (CAR) T-cell therapy. However, the prognostic relevance of CRS and ICANS, as well as immune effector cell-associated hematological toxicity (ICAHT), remains incompletely defined. In this multicenter retrospective study, adult patients with mature B-cell malignancies treated with CD19-directed CAR-T therapy between 2016 and 2024 at three academic centers were included. CRS and ICANS were graded according to ASTCT criteria, and early ICAHT according to EHA/EBMT consensus definitions. The primary endpoint was non-relapse mortality (NRM); secondary endpoints included overall survival (OS) and progression-free survival (PFS). Outcomes were evaluated using day 30 landmark analyses with multivariable models stratified by center and adjusted for clinically relevant covariates; a complementary sensitivity analysis modeled CRS as a time-dependent covariate for NRM in the full cohort from day 0. Among 560 patients, axi-cel was the most frequently used product (48%), followed by tisa-cel (25%), liso-cel (23%) and brexu-cel (4%). With a median follow-up of 23.9 months, the 2-year cumulative incidence of NRM for the full cohort was 7.2%, with 2-year OS and PFS of 57% and 41%, respectively. Overall, 140 patients (25%) and 61 (11%) developed grade 2 and grade 3 to 4 CRS, respectively; 40 (7%) and 74 (13%) developed grade 2 and grade 3 to 4 ICANS, respectively; and 151 (30%) and 144 (29%) developed grade 2 and grade 3 to 4 early ICAHT, respectively. In a day +30 landmark analysis adjusted for baseline covariates, CRS and early ICAHT severity was not independently associated with NRM, OS, or PFS. In contrast, grade ≥3 ICANS was independently associated with increased NRM (HR: 2.46, 95% CI, 1.00 to 6.04) and inferior OS (HR: 1.79, 95% CI, 1.14 to 2.81), but not with PFS. In the sensitivity analysis, grade 3 to 4 CRS was associated with NRM in univariable but not in multivariable analysis. In this real-world cohort of patients treated with CD19 CAR-T cells, we found that high grade ICANS retained independent prognostic significance for outcomes beyond day 30, whereas CRS and early ICAHT did not; however, severe CRS may still contribute to early treatment-related mortality. These findings support the clinical utility of modern grading systems for outcome interpretation and emphasize neurotoxicity as a priority for preventive interventions after CD19 CAR-T therapy.</div></div>","PeriodicalId":23283,"journal":{"name":"Transplantation and Cellular Therapy","volume":"32 10","pages":"Pages 1346.e1-1346.e12"},"PeriodicalIF":4.7,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148017546","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}