Hypogammaglobulinemia After Chimeric Antigen Receptor (CAR) T-Cell Therapy: Characteristics, Management, and Future Directions

Wat, Jeanette; Barmettler, Sara

doi:10.1016/j.jaip.2021.10.037

Cited by 43 publications

(29 citation statements)

References 44 publications

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“…Hypogammaglobulinemia is a common complication after CAR-T cell therapy, with one study demonstrating that 29% of patients had low IgG levels at 63 days post-CAR T-cell infusion (14). Of note, hypogammaglobulinemia is more common and more severe in pediatric as compared to adult patients and can persist for >4 years post infusion (5,15). Some experts suggest that pediatric CAR T cell recipients with IgG levels less than 400 mg/dl should receive regular supplementation of immune globulin.…”

Section: Discussionmentioning

confidence: 99%

Case report: Clinical course and treatment of SARS-CoV-2 in a pediatric CAR-T cell recipient with persistent hypogammaglobulinemia

et al. 2023

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This report describes a pediatric patient who underwent chimeric antigen receptor (CAR) T-cell therapy for refractory B-cell acute lymphoblastic leukemia (B-ALL) four years prior, with resultant hypogammaglobulinemia for which he was receiving weekly subcutaneous immune globulin. He presented with persistent fever, dry cough, and a tingling sensation in his toes following a confirmed COVID-19 infection 3 weeks prior. His initial nasopharyngeal SARS-CoV-2 PCR was negative, leading to an extensive workup for other infections. He was ultimately diagnosed with persistent lower respiratory tract COVID-19 infection based on positive SARS-CoV-2 PCR from bronchoalveolar lavage (BAL) sampling. He was treated with a combination of remdesivir (antiviral) and casirivimab/imdevimab (combination monoclonal antibodies) with immediate improvement in fever, respiratory symptoms, and neurologic symptoms.

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Section: Discussionmentioning

confidence: 99%

Case report: Clinical course and treatment of SARS-CoV-2 in a pediatric CAR-T cell recipient with persistent hypogammaglobulinemia

et al. 2023

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“…CAR-T cell treatment is a relatively new form of immunotherapy and can render patients immunocompromised for months or longer after treatment. The CD19-specific CAR-T cells that the patient received have “on-target, off-tumor” effects because the target antigen CD19, a transmembrane glycoprotein, is expressed on malignant as well as normal B-cells, resulting in B-cell aplasia and hypogammaglobulinaemia that can persist for months or even years [ 7 , 8 ].…”

Section: Discussionmentioning

confidence: 99%

Olecranon bursitis caused by Scedosporium apiospermum in a patient treated with CAR-T cells

Falkenburg

Jalink²,

Kersten³

et al. 2022

Medical Mycology Case Reports

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“…Patients can be transitioned from intravenous to subcutaneous immunoglobulin replacement to maintain an IgG level >1,000 mg/dL ( 40 ). Noteably, differences in hypogammaglobulinemia were found in children as compared to adults ( 125 ).…”

Section: Supportive Care In Selected New Therapies For Childhood Allmentioning

confidence: 99%

Supportive methods for childhood acute lymphoblastic leukemia then and now: A compilation for clinical practice

et al. 2022

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Survival of childhood acute lymphoblastic leukemia has significantly improved over the past decades. In the early years of chemotherapeutic development, improvement in survival rates could be attained only by increasing the cytostatic dose, also by modulation of the frequency and combination of chemotherapeutic agents associated with severe short- and long-time side-effects and toxicity in a developing child's organism. Years later, new treatment options have yielded promising results through targeted immune and molecular drugs, especially in relapsed and refractory leukemia, and are continuously added to conventional therapy or even replace first-line treatment. Compared to conventional strategies, these new therapies have different side-effects, requiring special supportive measures. Supportive treatment includes the prevention of serious acute and sometimes life-threatening events as well as managing therapy-related long-term side-effects and preemptive treatment of complications and is thus mandatory for successful oncological therapy. Inadequate supportive therapy is still one of the main causes of treatment failure, mortality, poor quality of life, and unsatisfactory long-term outcome in children with acute lymphoblastic leukemia. But nowadays it is a challenge to find a way through the flood of supportive recommendations and guidelines that are available in the literature. Furthermore, the development of new therapies for childhood leukemia has changed the range of supportive methods and must be observed in addition to conventional recommendations. This review aims to provide a clear and recent compilation of the most important supportive methods in the field of childhood leukemia, based on conventional regimes as well as the most promising new therapeutic approaches to date.

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Hypogammaglobulinemia After Chimeric Antigen Receptor (CAR) T-Cell Therapy: Characteristics, Management, and Future Directions

Cited by 43 publications

References 44 publications

Case report: Clinical course and treatment of SARS-CoV-2 in a pediatric CAR-T cell recipient with persistent hypogammaglobulinemia

Case report: Clinical course and treatment of SARS-CoV-2 in a pediatric CAR-T cell recipient with persistent hypogammaglobulinemia

Olecranon bursitis caused by Scedosporium apiospermum in a patient treated with CAR-T cells

Supportive methods for childhood acute lymphoblastic leukemia then and now: A compilation for clinical practice

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