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.
BMC Infect Dis. 2024 Oct 13;24(1):1147. doi: 10.1186/s12879-024-09893-x.
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.
卡氏肺孢子菌肺炎（PcP）是一种与免疫功能低下患者相关的机会性感染。新型免疫疗法的发展促进了 PcP 的发病率。本研究描述了血液恶性肿瘤嵌合抗原受体（CAR）T 细胞受者中 PcP 的临床过程和结局。
这是我们中心诊断为 PcP 的 CAR-T 受者的回顾性病例系列研究。所有病例均通过临床样本的宏基因组下一代测序得到证实。从患者的病历和电子病历系统中检索人口统计学、临床和结局数据。
共发现 8 例 PcP。基础恶性肿瘤包括 T 急性淋巴细胞白血病（ALL）（n=1）、弥漫性大 B 细胞淋巴瘤（DLBCL）（n=4）和 B-ALL（n=3）。1 例患者短期接受磺胺甲恶唑-甲氧苄啶（SMZ-TMP）治疗，其余患者无预防措施。4 例患者在诊断为 PcP 时存在中性粒细胞减少/淋巴细胞减少，2 例患者在 PcP 表现前一个月内使用免疫抑制剂。从 CAR-T 输注到 PcP 诊断的中位时间为 98.5 天（范围 52-251）。7 例患者经适当治疗后从 PcP 中恢复，1 例患者死于感染性休克。
不同的 CAR-T 产品后可发生 PcP，长期免疫细胞耗竭似乎与 PcP 有关。SMZ-TMP 在该环境中有效。需要更多的 CAR-T 治疗真实世界经验来评估该人群中 PcP 的发病率和结局。
