病毒性嵌合抗原受体-T 细胞疗法:潜伏和偶发病毒感染。

IF 3.6 3区 医学 Q2 INFECTIOUS DISEASES
Current Opinion in Infectious Diseases Pub Date : 2024-12-01 Epub Date: 2024-10-03 DOI:10.1097/QCO.0000000000001066
Eleftheria Kampouri, Gemma Reynolds, Benjamin W Teh, Joshua A Hill
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引用次数: 0

摘要

综述目的:感染是嵌合抗原受体(CAR)-T 细胞疗法后非复发死亡的主要原因,病毒感染在输注后的早期和晚期都很常见。我们回顾了病毒感染的流行病学,并讨论了在这种情况下预防和管理策略的关键方法:由于抗病毒预防措施的普及,单纯疱疹病毒和水痘带状疱疹病毒感染非常罕见,但巨细胞病毒(CMV)再活化的现象越来越多,尤其是在高危人群中,包括B细胞成熟抗原(BCMA)-CAR-T细胞治疗受者和接受皮质类固醇治疗的患者。虽然CMV终末器官疾病很少见,但CMV与死亡率升高有关,因此需要评估CMV对长期血液学、感染和生存结果的广泛影响。人类疱疹病毒-6(HHV-6)也已成为一个令人担忧的问题,其诊断因与神经毒性症状重叠而变得复杂,强调了在鉴别诊断中考虑病毒性脑炎的重要性。呼吸道病毒是最常见的晚期感染,在 BCMA CAR-T 细胞疗法后发病率更高。接种疫苗仍然是预防呼吸道病毒的关键措施,但在 CAR-T 细胞治疗后免疫原性可能会降低。摘要:需要更好地了解病毒流行病学和预防性试验,以改善CAR-T细胞疗法后的感染预防措施和治疗效果。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Chimeric antigen receptor-T-cell therapies going viral: latent and incidental viral infections.

Purpose of review: Infections are the leading cause of non-relapse mortality following chimeric antigen receptor (CAR)-T-cell therapy, with viral infections being frequent both in the early and late phases post-infusion. We review the epidemiology of viral infections and discuss critical approaches to prevention and management strategies in this setting.

Recent findings: Herpesviruses dominate the early period. herpes simplex virus and varicella zoster virus infections are rare due to widespread antiviral prophylaxis, but cytomegalovirus (CMV) reactivation is increasingly observed, particularly in high-risk groups including B cell maturation antigen (BCMA)-CAR-T-cell therapy recipients and patients receiving corticosteroids. While CMV end-organ disease is rare, CMV is associated with increased mortality, emphasizing the need to evaluate the broader impact of CMV on long-term hematological, infection, and survival outcomes. Human herpesvirus-6 (HHV-6) has also emerged as a concern, with its diagnosis complicated by overlapping symptoms with neurotoxicity, underscoring the importance of considering viral encephalitis in differential diagnoses. Respiratory viruses are the most common late infections with a higher incidence after BCMA CAR-T-cell therapy. Vaccination remains a critical preventive measure against respiratory viruses but may be less immunogenic following CAR-T-cell therapy. The optimal timing, type of vaccine, and dosing schedule require further investigation.

Summary: A better understanding of viral epidemiology and preventive trials are needed to improve infection prevention practices and outcomes following CAR-T-cell therapies.

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来源期刊
CiteScore
6.70
自引率
2.60%
发文量
121
审稿时长
6-12 weeks
期刊介绍: This reader-friendly, bimonthly resource provides a powerful, broad-based perspective on the most important advances from throughout the world literature. Featuring renowned guest editors and focusing exclusively on two topics, every issue of Current Opinion in Infectious Disease delivers unvarnished, expert assessments of developments from the previous year. Insightful editorials and on-the-mark invited reviews cover key subjects such as HIV infection and AIDS; skin and soft tissue infections; respiratory infections; paediatric and neonatal infections; gastrointestinal infections; tropical and travel-associated diseases; and antimicrobial agents.
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