Literature review of endemic infections on CAR-T-cell recipients
| Sex/age Local . | Type and time∗ of infectious diagnosis . | Diagnosis method . | Hematologic diagnosis . | Type of CAR-T . | Conditioning regimen . | CRS grade . | CRS/ICANS treatment† . | Time to cellular immune recovery, neutrophil/B cells . | Infectious treatment . | Outcomes . |
|---|---|---|---|---|---|---|---|---|---|---|
| F/9 Born in Pakistan living in Spain for the past 3 y | Tuberculosis (pulmonary) on day +64 | PCR of BAL | ALL | CAR19-T-Cell | FC | 3 | Dexametasone 0.6 mg/kg per day for 13 days; tocilizumab 8 mg/kg per dose for 2 doses; siltuximab 11 mg/kg for 1 dose; anakinra 2 mg/kg per day for 3 d | 5 mo/5 mo | HRZE | Relapse of ALL and died at day +94 |
| M/45 China | Tuberculosis (pulmonary) on day +23 | Xpert MTB/Rif (sputum) | MCL | CAR19 T cell/CAR22 T cell + tandem ASCT | BEAM | 2 | Dexametasone 10 mg for 3 d | 14 d/3 mo | 2HRZE/4HR | Alive |
| F/29 China | Tuberculosis (pulmonary and CNS) on day +66 | Xpert MTB/Rif (CSF) | ALL | CAR19 T cell/CAR22 T cell | FC | 1 | Suportive | 7 d/3 mo | 2HRZE | Relapse of ALL 4 months after CAR-T and lost to FU |
| M/60 China | Tuberculosis (pulmonary and CNS) on +8 mo | Xpert MTB/Rif (PE); TB PCR (CSF) | DLBCL | CAR19 T cell/ CAR22 T cell + tandem ASCT | BEAM | 1 | Suportive | 20 d/10 mo | 2HRZE | Death due to CNS tuberculosis |
| M/23 China | Tuberculosis (pulmonary and nodal) on +10 mo | PCR (mediastinal lymph node biopsy) | DLBCL | CAR19 T cell/CAR22 T cell + tandem ASCT | BEAM | 1 | Suportive | 9 d/13 mo | 3HRZE/9HER | Alive |
| F/63 China | Tuberculosis (subcutaneous and bone) on +11 mo | PCR (subcutaneous nodules biopsy) | FL | CAR19 T cell/CAR22 T cell | FC | 1 | Suportive | 10 d/N/A | 3HRZE/9HER | Alive |
| F/16 China | Tuberculosis (mediastinal lymph nodes) | N/A | ALL | CAR19 T cell | N/A | N/A | N/A | N/A | N/A | N/A |
| M/22 Brazil | Tuberculosis (CNS and pulmonary) on +3 mo | Xpert MTB/Rif (CSF) | DLBCL | CAR19 T cell Axicabtagene ciloleucel | FC | 2 | Dexamethasone accumulated dose of 170 mg; tocilizumab 8 mg/kg per dose for 1 dose | No recovery | 2HRZE | Died 5 months after CAR-T due to gastrointestinal hemorrhage |
| N/A USA | Coccidioidomycosis | N/A | N/A | CAR19 T cell | FC | N/A | N/A | N/A | N/A | N/A |
| F/24 Brazil | Cryptococcus sp. on day +20 | Skin biopsy | ALL | CAR19 T cell Tisagenlecleucel | FC | 3 | Dexamethasone 30 mg total dose; metilprednisolone 790 mg total dose; and tocilizumab 2 doses | No recovery | Not started (postmortem diagnosis) | Died 2 months after CAR-T due to disease progression |
| M/46 UK | Toxoplasma gondii (CNS) on +4 months | Brain biopsy and PCR (CSF) | ALL | CAR19 T cell | N/A | N/A | N/A | N/A | Pyrimethamine sulfadiazine and folinic acid | Alive |
| M/71 The Netherlands | MRI suggestive of toxoplasmosis on day +7 | MRI (serology tests were negative) | DLBCL | CAR19 T cell | FC | 1 | Suportive | N/A | Pyrimethamine sulfadiazine and folinic acid | Alive |
| M/54 USA | T gondii (pulmonary and CNS) on day +67 | Autopsy | DLBCL | CAR19 T cell | FC | 2 | Dexamethasone 10 mg every 6 hours for 3 d, methylprednisolone 1 mg/kg per day for 5 d, and tocilizumab for 3 doses | 26 d/ N/A | Not started (postmortem diagnosis) | Died 70 d after CAR-T due to disseminated toxoplasmosis |
| F/24 Brazil | G Lamblia on day +20 | Molecular panel for diarrhea | ALL | CAR19-T-cell | FC | 3 | Dexamethasone 30 mg total dose, metilprednisolone 790 mg total dose and tocilizumab 2 doses | No recovery | Metronidazole | Died 2 months after CAR-T-cell due to disease progression |
| F/64 Colombia | Trypanossoma cruzi reactivation on day +30 | Blood PCR | DLBCL | CAR19 T cell | FC + dexamethasone and lenalidomide | N/A | N/A | 9 d/N/A | Benznidazole | Alive |
| Sex/age Local . | Type and time∗ of infectious diagnosis . | Diagnosis method . | Hematologic diagnosis . | Type of CAR-T . | Conditioning regimen . | CRS grade . | CRS/ICANS treatment† . | Time to cellular immune recovery, neutrophil/B cells . | Infectious treatment . | Outcomes . |
|---|---|---|---|---|---|---|---|---|---|---|
| F/9 Born in Pakistan living in Spain for the past 3 y | Tuberculosis (pulmonary) on day +64 | PCR of BAL | ALL | CAR19-T-Cell | FC | 3 | Dexametasone 0.6 mg/kg per day for 13 days; tocilizumab 8 mg/kg per dose for 2 doses; siltuximab 11 mg/kg for 1 dose; anakinra 2 mg/kg per day for 3 d | 5 mo/5 mo | HRZE | Relapse of ALL and died at day +94 |
| M/45 China | Tuberculosis (pulmonary) on day +23 | Xpert MTB/Rif (sputum) | MCL | CAR19 T cell/CAR22 T cell + tandem ASCT | BEAM | 2 | Dexametasone 10 mg for 3 d | 14 d/3 mo | 2HRZE/4HR | Alive |
| F/29 China | Tuberculosis (pulmonary and CNS) on day +66 | Xpert MTB/Rif (CSF) | ALL | CAR19 T cell/CAR22 T cell | FC | 1 | Suportive | 7 d/3 mo | 2HRZE | Relapse of ALL 4 months after CAR-T and lost to FU |
| M/60 China | Tuberculosis (pulmonary and CNS) on +8 mo | Xpert MTB/Rif (PE); TB PCR (CSF) | DLBCL | CAR19 T cell/ CAR22 T cell + tandem ASCT | BEAM | 1 | Suportive | 20 d/10 mo | 2HRZE | Death due to CNS tuberculosis |
| M/23 China | Tuberculosis (pulmonary and nodal) on +10 mo | PCR (mediastinal lymph node biopsy) | DLBCL | CAR19 T cell/CAR22 T cell + tandem ASCT | BEAM | 1 | Suportive | 9 d/13 mo | 3HRZE/9HER | Alive |
| F/63 China | Tuberculosis (subcutaneous and bone) on +11 mo | PCR (subcutaneous nodules biopsy) | FL | CAR19 T cell/CAR22 T cell | FC | 1 | Suportive | 10 d/N/A | 3HRZE/9HER | Alive |
| F/16 China | Tuberculosis (mediastinal lymph nodes) | N/A | ALL | CAR19 T cell | N/A | N/A | N/A | N/A | N/A | N/A |
| M/22 Brazil | Tuberculosis (CNS and pulmonary) on +3 mo | Xpert MTB/Rif (CSF) | DLBCL | CAR19 T cell Axicabtagene ciloleucel | FC | 2 | Dexamethasone accumulated dose of 170 mg; tocilizumab 8 mg/kg per dose for 1 dose | No recovery | 2HRZE | Died 5 months after CAR-T due to gastrointestinal hemorrhage |
| N/A USA | Coccidioidomycosis | N/A | N/A | CAR19 T cell | FC | N/A | N/A | N/A | N/A | N/A |
| F/24 Brazil | Cryptococcus sp. on day +20 | Skin biopsy | ALL | CAR19 T cell Tisagenlecleucel | FC | 3 | Dexamethasone 30 mg total dose; metilprednisolone 790 mg total dose; and tocilizumab 2 doses | No recovery | Not started (postmortem diagnosis) | Died 2 months after CAR-T due to disease progression |
| M/46 UK | Toxoplasma gondii (CNS) on +4 months | Brain biopsy and PCR (CSF) | ALL | CAR19 T cell | N/A | N/A | N/A | N/A | Pyrimethamine sulfadiazine and folinic acid | Alive |
| M/71 The Netherlands | MRI suggestive of toxoplasmosis on day +7 | MRI (serology tests were negative) | DLBCL | CAR19 T cell | FC | 1 | Suportive | N/A | Pyrimethamine sulfadiazine and folinic acid | Alive |
| M/54 USA | T gondii (pulmonary and CNS) on day +67 | Autopsy | DLBCL | CAR19 T cell | FC | 2 | Dexamethasone 10 mg every 6 hours for 3 d, methylprednisolone 1 mg/kg per day for 5 d, and tocilizumab for 3 doses | 26 d/ N/A | Not started (postmortem diagnosis) | Died 70 d after CAR-T due to disseminated toxoplasmosis |
| F/24 Brazil | G Lamblia on day +20 | Molecular panel for diarrhea | ALL | CAR19-T-cell | FC | 3 | Dexamethasone 30 mg total dose, metilprednisolone 790 mg total dose and tocilizumab 2 doses | No recovery | Metronidazole | Died 2 months after CAR-T-cell due to disease progression |
| F/64 Colombia | Trypanossoma cruzi reactivation on day +30 | Blood PCR | DLBCL | CAR19 T cell | FC + dexamethasone and lenalidomide | N/A | N/A | 9 d/N/A | Benznidazole | Alive |
ASCT, Autologous stem cell transplantation; BAL, bronchoalveolar lavage; BEAM, carmusitine, etoposide, cytarabine, and melphalan; CAR19, CD19-targeted CAR; CSF, cerebrospinal fluid; F, female; FC, fludarabine and cyclophosphamide; FU, follow-up; HRZE, rifampicin, isoniazid, pyrazinamide, and ethambutol; M, male; MCL, mantle cell lymphoma; MM, multiple myeloma; MRI, magnetic resonance imaging; N/A not available; PE, pleural effusion.
Days after CAR-T infusion.
Includes steroids, tocilizumab, and anakinra.