Human herpesvirus 6 myelitis after chimeric antigen receptor T-cell therapy

Guy Handley; Fareed Khawaja; Divya S Kondapi; Hun J Lee; Gregory P Kaufman; Sattva S Neelapu; Luis E Fayad; Sudhakar Tummala; Linda Chi; Paolo Strati; Victor E Mulanovich

doi:10.1016/j.ijid.2021.09.061

Human herpesvirus 6 myelitis after chimeric antigen receptor T-cell therapy

Int J Infect Dis. 2021 Nov:112:327-329. doi: 10.1016/j.ijid.2021.09.061. Epub 2021 Sep 29.

Authors

Affiliations

¹ Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, TX, USA; Department of Medicine, Division of Infectious Disease and International Medicine, Morsani College of Medicine, University of South Florida, Tampa, FL, USA. Electronic address: [email protected].
² Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
³ Department of Lymphoma-Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
⁴ Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
⁵ Department of Neuroradiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.

PMID: 34600133
DOI: 10.1016/j.ijid.2021.09.061

Abstract

This article reports a fatal case of human herpesvirus 6 (HHV-6) myelitis following CD19-targeted chimeric antigen receptor T-cell therapy. Infection from HHV-6 reactivation after haematopoietic stem cell transplant is established, and outside of this population is limited to case reports. The patient developed cytokine release syndrome and immune effector cell-associated neurotoxicity syndrome that responded to corticosteroids both clinically and on imaging. Subsequently, ascending flaccid paralysis developed, leading to neuromuscular respiratory failure and, ultimately, death. Disease progression was refractory to foscarnet and multiple immunomodulating agents. HHV-6 should be considered in patients with encephalitis and myelitis after adoptive T-cell therapy.

Keywords: CAR T-cell therapy; Human herpesvirus-6; Myelitis.

Publication types

Case Reports

MeSH terms

Cell- and Tissue-Based Therapy
Herpesvirus 6, Human*
Humans
Immunotherapy, Adoptive
Myelitis* / drug therapy
Myelitis* / etiology
Receptors, Chimeric Antigen*

Substances

Receptors, Chimeric Antigen