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Cytomegalovirus (CMV) Reactivation and CMV-Specific Cell-Mediated Immunity After Chimeric Antigen Receptor T-Cell Therapy.
Kampouri, Eleftheria; Ibrahimi, Sarah S; Xie, Hu; Wong, Elizabeth R; Hecht, Jessica B; Sekhon, Mandeep K; Vo, Alythia; Stevens-Ayers, Terry L; Green, Damian J; Gauthier, Jordan; Maloney, David G; Perez, Ailyn; Jerome, Keith R; Leisenring, Wendy M; Boeckh, Michael J; Hill, Joshua A.
Afiliação
  • Kampouri E; Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, Seattle, Washington, USA.
  • Ibrahimi SS; Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, Seattle, Washington, USA.
  • Xie H; Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, Washington, USA.
  • Wong ER; Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, Seattle, Washington, USA.
  • Hecht JB; Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, Seattle, Washington, USA.
  • Sekhon MK; Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, Seattle, Washington, USA.
  • Vo A; Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, Seattle, Washington, USA.
  • Stevens-Ayers TL; Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, Seattle, Washington, USA.
  • Green DJ; Translational Science and Therapeutics Division, Fred Hutchinson Cancer Center, Seattle, Washington, USA.
  • Gauthier J; Department of Medicine, University of Washington, Seattle, Washington, USA.
  • Maloney DG; Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, Washington, USA.
  • Perez A; Department of Medicine, University of Washington, Seattle, Washington, USA.
  • Jerome KR; Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, Washington, USA.
  • Leisenring WM; Department of Medicine, University of Washington, Seattle, Washington, USA.
  • Boeckh MJ; Department of Laboratory Medicine and Pathology, University of Washington, Seattle, Washington, USA.
  • Hill JA; Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, Seattle, Washington, USA.
Clin Infect Dis ; 78(4): 1022-1032, 2024 Apr 10.
Article em En | MEDLINE | ID: mdl-37975819
BACKGROUND: The epidemiology of cytomegalovirus (CMV) after chimeric antigen receptor-modified T-cell immunotherapy (CARTx) is poorly understood owing to a lack of routine surveillance. METHODS: We prospectively enrolled 72 adult CMV-seropositive CD19-, CD20-, or BCMA-targeted CARTx recipients and tested plasma samples for CMV before and weekly up to 12 weeks after CARTx. We assessed CMV-specific cell-mediated immunity (CMV-CMI) before and 2 and 4 weeks after CARTx, using an interferon γ release assay to quantify T-cell responses to IE-1 and pp65. We tested pre-CARTx samples to calculate a risk score for cytopenias and infection (CAR-HEMATOTOX). We used Cox regression to evaluate CMV risk factors and evaluated the predictive performance of CMV-CMI for CMV reactivation in receiver operator characteristic curves. RESULTS: CMV was detected in 1 patient (1.4%) before and in 18 (25%) after CARTx, for a cumulative incidence of 27% (95% confidence interval, 16.8-38.2). The median CMV viral load (interquartile range) was 127 (interquartile range, 61-276) IU/mL, with no end-organ disease observed; 5 patients received preemptive therapy based on clinical results. CMV-CMI values reached a nadir 2 weeks after infusion and recovered to baseline levels by week 4. In adjusted models, BCMA-CARTx (vs CD19/CD20) and corticosteroid use for >3 days were significantly associated with CMV reactivation, and possible associations were detected for lower week 2 CMV-CMI and more prior antitumor regimens. The cumulative incidence of CMV reactivation almost doubled when stratified by BCMA-CARTx target and use of corticosteroids for >3 days (46% and 49%, respectively). CONCLUSIONS: CMV testing could be considered between 2 and 6 weeks in high-risk CARTx recipients.
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Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Infecções por Citomegalovirus / Receptores de Antígenos Quiméricos Limite: Adult / Humans Idioma: En Revista: Clin Infect Dis Assunto da revista: DOENCAS TRANSMISSIVEIS Ano de publicação: 2024 Tipo de documento: Article País de afiliação: Estados Unidos

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Infecções por Citomegalovirus / Receptores de Antígenos Quiméricos Limite: Adult / Humans Idioma: En Revista: Clin Infect Dis Assunto da revista: DOENCAS TRANSMISSIVEIS Ano de publicação: 2024 Tipo de documento: Article País de afiliação: Estados Unidos