Case Report: Invasive fungal infection after anti-CD19 CAR-T cell therapy. Implication for antifungal prophylaxis

Front Immunol. 2023 Sep 28:14:1272798. doi: 10.3389/fimmu.2023.1272798. eCollection 2023.

Abstract

CAR-T therapy has revolutionized the treatment of relapsed/refractory B-cell malignancies. Patients who are receiving such therapy are susceptible to an increased incidence of infections due to post-treatment immunosuppression. The need for antifungal prophylaxis during the period of neutropenia remains to be determined. The clinical outcome of a 55-year-old patient with relapsed/refractory DLBCL who received axicabtagene ciloleucel is described here. The patient developed CRS grade II and ICANS grade IV requiring tocilizumab, prolonged use of steroids and anakinra. An invasive pulmonary aspergillosis arose after 1 month from CAR-T reinfusion, resolved with tracheal sleeve pneumonectomy. The patient is now in Complete Remission. This case suggests that antifungal prophylaxis should be considered. We have now included micafungin as a standard prophylaxis in our institution.

Keywords: CAR-T cell therapy; antifungal prophylaxis; case report; immunotherapy; invasive aspergillosis.

Publication types

  • Case Reports
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Antifungal Agents / therapeutic use
  • Antigens, CD19 / therapeutic use
  • Cell- and Tissue-Based Therapy
  • Humans
  • Invasive Fungal Infections* / drug therapy
  • Invasive Fungal Infections* / etiology
  • Invasive Fungal Infections* / prevention & control
  • Middle Aged
  • Neoplasm Recurrence, Local / drug therapy
  • Receptors, Chimeric Antigen*

Substances

  • Receptors, Chimeric Antigen
  • Antifungal Agents
  • Antigens, CD19

Grants and funding

The authors declare financial support was received for the research, authorship, and/or publication of this article. This work was supported by the Associazione Italiana contro le Leucemie-Linfomi e Mieloma (AIL), L’Aquila Section, Italy.