ABSTRACT
Chimeric antigen receptor (CAR) T-cell therapy is one of the most promising emerging treatments for B-cell malignancies. Recently, two CAR T-cell products (axicabtagene ciloleucel and tisagenlecleucel) have been approved for patients with aggressive B-cell lymphoma and acute lymphoblastic leukemia; many other CAR-T constructs are in research for both hematological and non-hematological diseases. Most of the patients receiving CAR-T therapy will develop fever at some point after infusion, mainly due to cytokine release syndrome (CRS). The onset of CRS is often indistinguishable from an infection, which makes management of these patients challenging. In addition to the lymphodepleting chemotherapy and CAR T cells, the treatment of complications with corticosteroids and/or tocilizumab increases the risk of infection in these patients. Data regarding incidence, risk factors and prevention of infections in patients receiving CAR-T cell therapy are scarce. To assist in patient care, a multidisciplinary team from hospitals designated by the Spanish Ministry of Health to perform CAR-T therapy prepared these recommendations. We reviewed the literature on the incidence, risk factors, and management of infections in adult and pediatric patients receiving CAR-T cell treatment. Recommendations cover different areas: monitoring and treatment of hypogammaglobulinemia, prevention, prophylaxis, and management of bacterial, viral, and fungal infections as well as vaccination prior and after CAR-T cell therapy.
Subject(s)
Bacterial Infections/prevention & control , Immunotherapy, Adoptive , Mycoses , Neoplasms , Virus Diseases/prevention & control , Adult , Child , Humans , Mycoses/prevention & control , Neoplasms/therapy , Risk Factors , T-LymphocytesABSTRACT
Los protocolos de prevención de la enfermedad por estreptococo del grupo B se emplean ampliamente y su eficacia ha sido demostrada. El objetivo del estudio es evaluar la aplicación del cribado de EGB en nuestro centro de trabajo, que recomienda efectuar un cultivo vaginal y rectal a todas las embarazadas en las semanas 35-37 de gestación, mediante un estudio de cohortes retrospectivo entre enero 2003 y enero 2004. Se objetiva una buena aplicación del cribado (92,1%), que sólo podría mejorarse parcialmente. En efecto, existen limitaciones inherentes a dicha estrategia, que podrían resolverse con la introducción de tests de detección rápida de portadoras al inicio del trabajo de parto (AU)
Protocols for the prevention of group B streptococcal disease are being widely used with proven efficacy. The aim of this study was to assess compliance with a culture-based approach recommending universal culture screening at 35-37 weeks' gestation, established in our hospital. A retrospective cohort study was undertaken from January 2003 to January 2004. Compliance with the culture-based approach was considered to be good (92.1%) and only partially amenable to improvements. Effectively, there are inherent limitations to the protocol that can be resolved with the use of other strategies, such as tests for quick identification of genital carrier status (AU)
Subject(s)
Male , Female , Infant, Newborn , Humans , Streptococcus agalactiae/isolation & purification , Bacterial Infections/prevention & control , Mass Screening , Retrospective Studies , Sepsis/microbiology , Infant, Newborn, Diseases/prevention & controlABSTRACT
Protocols for the prevention of group B streptococcal disease are being widely used with proven efficacy. The aim of this study was to assess compliance with a culture-based approach recommending universal culture screening at 35-37 weeks' gestation, established in our hospital. A retrospective cohort study was undertaken from January 2003 to January 2004. Compliance with the culture-based approach was considered to be good (92.1%) and only partially amenable to improvements. Effectively, there are inherent limitations to the protocol that can be resolved with the use of other strategies, such as tests for quick identification of genital carrier status.
