Outcome of Pneumocystis Jirovecii pneumonia (PcP) in post-CAR-T patients with hematological malignancies.

Oct 14, 2024

Experts: Cheng Zu,Wenxiao Li,Mingming Zhang,Yetian Dong,Shan Fu,Jingjing Feng,Ruimin Hong,He Huang,Yongxian Hu,Junwei Su

Pneumocystis jirovecii pneumonia (PcP) is an opportunistic infection associated with immunocompromised patients. The development of novel immunotherapies has promoted the incidence of PcP. This study describes the clinical course and outcome of PcP in chimeric antigen receptor (CAR) T cell recipients with hematological malignancies.
This is a retrospective case series of CAR-T recipients diagnosed with PcP in our center. The cases were all confirmed by metagenomic next-generation sequencing of clinical samples. The demographic, clinical, and outcome data were retrieved from the patients’ medical charts and electronic medical record system.
In total, 8 cases of PcP were identified. The underlying malignancies included T-acute lymphoblastic leukemia (ALL) (n = 1), diffuse large B cell lymphoma (DLBCL) (n = 4), and B-ALL (n = 3). One patient received short-term sulfamethoxazole-trimethoprim (SMZ-TMP) while the others had no prophylaxis. Four patients had neutropenia/lymphopenia at the diagnosis of PcP, and two patients had immunosuppressants within one month before PcP manifestation. The median time from CAR-T infusion to PcP diagnosis was 98.5 days (range 52-251). Seven patients recovered from PcP after proper management while one died of septic shock.
PcP can occur after different CAR-T product, and the long-term depletion of immune cells seems to be related to PcP. SMZ-TMP is effective in this setting. More real-world experience of CAR-T therapy is required to assess the incidence and outcome of PcP in this population.

© 2024. The Author(s).

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ABOUT THE EXPERTS

Cheng Zu,Wenxiao Li,Mingming Zhang,Yetian Dong,Shan Fu,Jingjing Feng,Ruimin Hong,He Huang,Yongxian Hu,Junwei Su

Cheng Zu

Bone Marrow Transplantation Center, the First Affiliated Hospital, Zhejiang University School of Medicine, No.79 Qingchun Road, Hangzhou, China.

Liangzhu Laboratory, Zhejiang University Medical Center, 1369 West Wenyi Road, Hangzhou, 311121, China.

Institute of Hematology, Zhejiang University, Hangzhou, China.

Zhejiang Province Engineering Laboratory for Stem Cell and Immunity Therapy, Hangzhou, China.

Wenxiao Li

Bone Marrow Transplantation Center, the First Affiliated Hospital, Zhejiang University School of Medicine, No.79 Qingchun Road, Hangzhou, China.

Liangzhu Laboratory, Zhejiang University Medical Center, 1369 West Wenyi Road, Hangzhou, 311121, China.

Institute of Hematology, Zhejiang University, Hangzhou, China.

Zhejiang Province Engineering Laboratory for Stem Cell and Immunity Therapy, Hangzhou, China.

Mingming Zhang

Bone Marrow Transplantation Center, the First Affiliated Hospital, Zhejiang University School of Medicine, No.79 Qingchun Road, Hangzhou, China.

Liangzhu Laboratory, Zhejiang University Medical Center, 1369 West Wenyi Road, Hangzhou, 311121, China.

Institute of Hematology, Zhejiang University, Hangzhou, China.

Zhejiang Province Engineering Laboratory for Stem Cell and Immunity Therapy, Hangzhou, China.

Yetian Dong

Bone Marrow Transplantation Center, the First Affiliated Hospital, Zhejiang University School of Medicine, No.79 Qingchun Road, Hangzhou, China.

Liangzhu Laboratory, Zhejiang University Medical Center, 1369 West Wenyi Road, Hangzhou, 311121, China.

Institute of Hematology, Zhejiang University, Hangzhou, China.

Zhejiang Province Engineering Laboratory for Stem Cell and Immunity Therapy, Hangzhou, China.

Shan Fu

Bone Marrow Transplantation Center, the First Affiliated Hospital, Zhejiang University School of Medicine, No.79 Qingchun Road, Hangzhou, China.

Liangzhu Laboratory, Zhejiang University Medical Center, 1369 West Wenyi Road, Hangzhou, 311121, China.

Institute of Hematology, Zhejiang University, Hangzhou, China.

Zhejiang Province Engineering Laboratory for Stem Cell and Immunity Therapy, Hangzhou, China.

Jingjing Feng

Bone Marrow Transplantation Center, the First Affiliated Hospital, Zhejiang University School of Medicine, No.79 Qingchun Road, Hangzhou, China.

Liangzhu Laboratory, Zhejiang University Medical Center, 1369 West Wenyi Road, Hangzhou, 311121, China.

Institute of Hematology, Zhejiang University, Hangzhou, China.

Zhejiang Province Engineering Laboratory for Stem Cell and Immunity Therapy, Hangzhou, China.

Ruimin Hong

Bone Marrow Transplantation Center, the First Affiliated Hospital, Zhejiang University School of Medicine, No.79 Qingchun Road, Hangzhou, China.

Liangzhu Laboratory, Zhejiang University Medical Center, 1369 West Wenyi Road, Hangzhou, 311121, China.

Institute of Hematology, Zhejiang University, Hangzhou, China.

Zhejiang Province Engineering Laboratory for Stem Cell and Immunity Therapy, Hangzhou, China.

He Huang

Bone Marrow Transplantation Center, the First Affiliated Hospital, Zhejiang University School of Medicine, No.79 Qingchun Road, Hangzhou, China. huanghe@zju.edu.cn.

Liangzhu Laboratory, Zhejiang University Medical Center, 1369 West Wenyi Road, Hangzhou, 311121, China. huanghe@zju.edu.cn.

Institute of Hematology, Zhejiang University, Hangzhou, China. huanghe@zju.edu.cn.

Zhejiang Province Engineering Laboratory for Stem Cell and Immunity Therapy, Hangzhou, China. huanghe@zju.edu.cn.

Yongxian Hu

Bone Marrow Transplantation Center, the First Affiliated Hospital, Zhejiang University School of Medicine, No.79 Qingchun Road, Hangzhou, China. 1313016@zju.edu.cn.

Liangzhu Laboratory, Zhejiang University Medical Center, 1369 West Wenyi Road, Hangzhou, 311121, China. 1313016@zju.edu.cn.

Institute of Hematology, Zhejiang University, Hangzhou, China. 1313016@zju.edu.cn.

Zhejiang Province Engineering Laboratory for Stem Cell and Immunity Therapy, Hangzhou, China. 1313016@zju.edu.cn.

Junwei Su

The Department of Infectious Diseases, State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, the First Affiliated Hospital, School of Medicine, Zhejiang University, No. 79 Qingchun Road, Hangzhou, China. zjusujunwei@zju.edu.cn.