Late-Onset Invasive Aspergillosis With Pituitary Involvement and Dysfunction Following CD19 Chimeric Antigen Receptor
Daisuke Ikeda1,2, Tomohiro Nawada3, Takumi Kondo2
1Department of Hematology, Oncology and Respiratory Medicine Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Okayama Japan.
Introduction:
Invasive fungal infection (IFI) after chimeric antigen receptor (CAR) T-cell therapy is less common than bacterial and viral infections, but can be fatal once it develops. As most cases occur within 30 days after CAR T-cell infusion, late-onset IFI-particularly mould infection-appears to be under-recognised.
Discussion:
We report an illustrative case of pituitary aspergillosis developing as late as one year after CD19 CAR T-cell therapy, highlighting a persistent risk in certain patients with delayed immune reconstitution.
Conclusion:
This case underscores the need for continued vigilance and individualised antifungal strategies to prevent IFI beyond the early post-infusion period.
Trial Registration:
The authors have confirmed clinical trial registration is not needed for this submission.
Insights
Late-onset invasive fungal infections, like pituitary aspergillosis, can occur over a year after chimeric antigen receptor (CAR) T-cell therapy. This highlights a persistent risk and the need for ongoing antifungal vigilance in certain patients.
Area of Science:
- Immunology
- Infectious Diseases
- Oncology
Background:
- Invasive fungal infections (IFIs) are a serious complication following chimeric antigen receptor (CAR) T-cell therapy.
- While bacterial and viral infections are more common, IFIs, particularly mould infections, can be fatal.
- Most IFIs occur within 30 days post-infusion, leading to under-recognition of late-onset cases.
Purpose of the Study:
- To highlight the under-recognized risk of late-onset invasive fungal infections after CAR T-cell therapy.
- To present a case of pituitary aspergillosis occurring one year post-infusion.
- To emphasize the need for sustained vigilance and tailored antifungal strategies.
Main Methods:
- Case report of a patient who developed pituitary aspergillosis.
- Analysis of the patient's timeline of CAR T-cell therapy and infection onset.
- Review of literature regarding late-onset IFIs post-CAR T-cell therapy.
Main Results:
- A patient developed pituitary aspergillosis as late as one year after CD19 CAR T-cell therapy.
- This case illustrates a persistent risk of IFI in patients with delayed immune reconstitution.
- Late-onset mould infections pose a significant, often overlooked, threat.
Conclusions:
- Vigilance for invasive fungal infections should extend beyond the early post-CAR T-cell infusion period.
- Individualised antifungal strategies are crucial for managing the persistent risk of IFIs.
- Delayed immune reconstitution can predispose patients to late-onset fungal complications.
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