Coccidioidomycosis, immunoglobulin deficiency: Safety challenges with CAR T cells therapy for relapsed lymphoma

Umar Zahid, Al Aman Shaukat, Nida Hassan, Faiz Anwer

Research output: Contribution to journalArticle

3 Scopus citations

Abstract

Treatment of patients with relapsed or refractory lymphoma may require allogenic hematopoietic stem cell transplant (HSCT), but treatment of post-transplant relapse disease remains very challenging. Donor lymphocyte infusion and blinatumomab have been used with limited success for the treatment of relapse. Initial data on donor-derived CAR T cells has shown this modality to be safe and highly effective in various hematological malignancies. We present a case of a patient with highly refractory, transformed follicular lymphoma who failed both autologous and allogenic HSCT. Patient achieved long-lasting complete remission with the use of donor origin CD19 CAR T-cell therapy, without any evidence of graft-versus-host disease flare. Our patient later developed disseminated coccidioidomycosis and persistent hypogammaglobulinemia. Immunotherapy using CD19 CAR T cells can be a highly effective salvage modality, especially in cases of focal lymphoma relapse. Long-term immunosuppression secondary to B cell lymphopenia, hypogammaglobulinemia, immunoglobulin subclass deficiency, fungal infections and other infectious complications need to be monitored and promptly treated as indicated.

Original languageEnglish (US)
Pages (from-to)1061-1066
Number of pages6
JournalImmunotherapy
Volume9
Issue number13
DOIs
StatePublished - Oct 2017

Keywords

  • coccidioidomycosis
  • donor-derived CAR T cell
  • immunoglobulin deficiency

ASJC Scopus subject areas

  • Immunology and Allergy
  • Immunology
  • Oncology

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