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.
Subject(s)
Invasive Fungal Infections , Receptors, Chimeric Antigen , Humans , Middle Aged , Antifungal Agents/therapeutic use , Neoplasm Recurrence, Local/drug therapy , Antigens, CD19/therapeutic use , Invasive Fungal Infections/drug therapy , Invasive Fungal Infections/etiology , Invasive Fungal Infections/prevention & control , Cell- and Tissue-Based TherapyABSTRACT
Tracheal sleeve pneumonectomy is considered the operation of choice for tumors involving the right tracheobronchial angle, even though the procedure is burdened by a high rate of perioperative morbidity and mortality. In this report, we present our experience with two different techniques to avoid sleeve pneumonectomy: the tangential tracheal suture and the tracheoplasty.