Disseminated toxoplasmosis and haemophagocytic lymphohistiocytosis following chimeric antigen receptor T‐cell therapy

Kator, Sarah; Zurko, Jessica; Webb, Brandon; Balatico, Michael; Clayton, Frederic; Palmer, Cheryl A.; Konopa, Kelly; Motyckova, Gabriela; Ford, Clyde D.; Ostronoff, Fabiana

doi:10.1111/bjh.16402

Cited by 5 publications

(3 citation statements)

References 11 publications

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“…A recent study by Neill et al demonstrated that glucocorticoids use was significantly associated with higher risk of infection, and rapid steroid taper was necessary (41). Infestations following CAR-T therapy which include bacterial, viral, fungal, and protozoal infection are dangerous and even fatal in these patients with weakened immune systems, so it is important to emphasize the importance of immunological monitoring to guide the strategies of antimicrobial prophylaxis for these patients, especially those with glucocorticoids management (34,35,(39)(40)(41)(42)(43). In addition to infection, prolonged use of glucocorticoids may affect mental state, blood pressure, blood sugar and other vital physiological indicators, so for those who could not effectively respond to glucocorticoid in time, alternative strategies such as intrathecal cytotoxic chemotherapy and siltuximab that has a small molecular size than tocilizumab could be considered to avoid increasing glucocorticoid-related side effects (39,44,45).…”

Section: Discussionmentioning

confidence: 99%

The Association Between Glucocorticoid Administration and the Risk of Impaired Efficacy of Axicabtagene Ciloleucel Treatment: A Systematic Review

et al. 2021

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BackgroundGlucocorticoid is one of the common and important strategies for the treatment of chimeric antigen receptor T (CAR-T) cell therapy-related toxicity. However, there has been a theoretical concern about whether glucocorticoids use can impact the expansion of CAR-T cells and thus impair its efficacy. Hence, we reviewed studies related to the Axicabtagene ciloleucel (Axi-cel), a first-class and widely used CAR-T cell product, to elucidate the association between glucocorticoids administration and efficacy of Axi-cel.MethodWe systematically searched PubMed, Embase, Web of Science, and Cochrane Library to identify studies of Axi-cel that used glucocorticoids as an intervention for the treatment of CAR-T cell-related adverse events and respectively evaluated any efficacy endpoints of intervention and controlled cohorts, published up to February 17, 2020. There were no restrictions on research type and language.ResultsA total of eight studies with 706 patients were identified in the systematic review. Except for one study found that high cumulative dose, prolonged duration and early use of glucocorticoids could shorten progression-free survival and/or overall survival, and another study that found a negative effect of glucocorticoids administration on overall survival in univariate analysis but disappeared in multivariate analysis, none of other studies observed a statistically significant association between glucocorticoids administration and progression-free survival, overall survival, complete response, and overall response rate.ConclusionOur study indicated that the association between glucocorticoids therapy and the efficacy of CAR-T cell may be affected by cumulative dose, duration, and timing. There is currently no robust evidence that glucocorticoids can damage the efficacy of CAR-T cell, but the early use of glucocorticoids should be cautiously recommended.

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Section: Discussionmentioning

confidence: 99%

The Association Between Glucocorticoid Administration and the Risk of Impaired Efficacy of Axicabtagene Ciloleucel Treatment: A Systematic Review

et al. 2021

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“…To our knowledge, only eight cases of DT-HLH have been reported in the literature so far (Supplementary Table 1) (Blanche et al, 1994;Guillaume et al, 2006;Segall et al, 2006;Duband et al, 2008;Yang et al, 2013;Gay et al, 2019;Kator et al, 2020;Sanchez-Petitto et al, 2020). The mean age of the previously reported patients was 39 years (range, 25-59 years); 88% were male.…”

Section: Discussionmentioning

confidence: 99%

Disseminated Toxoplasmosis associated with Haemophagocytic Lymphohistiocytosis in a Patient with the Human Immunodeficiency Virus: A Case Report and Literature Review

Washino¹,

Mikita²,

Kosaka³

et al. 2022

International Journal of Infectious Diseases

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“…However, we also presume that toxoplasmosis may induce histiocytosis, as several studies have reported cases of hemophagocytic lymphohistiocytosis triggered by disseminated toxoplasmosis (19)(20)(21)(22), and Rosai-Dorfman disease, which is characterized by sinus histiocytosis with massive lymphadenopathy, accompanied by latent toxoplasmosis (23,24). Infection of monocytes with T. gondii tachyzoites strongly induces innate immune responses such as the production of proinflammatory cytokines (25).…”

Section: Figure 3 Other Radiologic Findings On 99m Tc-mdp Bone Scinti...mentioning

confidence: 98%

Erdheim-Chester Disease Involving the Central Nervous System with Latent Toxoplasmosis

et al. 2022

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Erdheim-Chester disease (ECD) is a rare, non-Langerhans cell histiocytosis characterized by the infiltration of foamy histiocytes into multiple organs. We herein report a case of ECD with central nervous system (CNS) involvement in a 63-year-old man who also presented a positive result for Toxoplasma gondii nested polymerase chain reaction testing of cerebrospinal fluid. Since anti-Toxoplasma treatment proved completely ineffective, we presumed latent infection of the CNS with T. gondii. This case suggests the difficulty of distinguishing ECD with CNS involvement from toxoplasmic encephalitis and the possibility of a relationship between the pathogeneses of ECD and infection with T. gondii.

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Disseminated toxoplasmosis and haemophagocytic lymphohistiocytosis following chimeric antigen receptor T‐cell therapy

Cited by 5 publications

References 11 publications

The Association Between Glucocorticoid Administration and the Risk of Impaired Efficacy of Axicabtagene Ciloleucel Treatment: A Systematic Review

The Association Between Glucocorticoid Administration and the Risk of Impaired Efficacy of Axicabtagene Ciloleucel Treatment: A Systematic Review

Disseminated Toxoplasmosis associated with Haemophagocytic Lymphohistiocytosis in a Patient with the Human Immunodeficiency Virus: A Case Report and Literature Review

Erdheim-Chester Disease Involving the Central Nervous System with Latent Toxoplasmosis

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