ArticleTransplantation and cellular therapy2025
Shift from Widespread to Tailored Antifungal Prophylaxis in Lymphoma Patients Treated with CD19 CAR T Cell Therapy: Results from a Large Retrospective Cohort.
Article in Transplantation and cellular therapy, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 9 papers.
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Who cites it
9 citing papers in PubMed.
- Phase 2, open-label, noncomparative clinical trial evaluating safety and efficacy of posaconazole in pediatric patients with proven/probable invasive aspergillosis or possible invasive fungal disease.Antimicrobial agents and chemotherapy · 2026Trial
- Safety Profile of Chimeric Antigen Receptor T-cell Therapies in Diffuse Large B-cell Lymphoma: An Analysis of Real-World Adverse Event Reporting From the FDA Adverse Event Reporting System.Mayo Clinic proceedings. Innovations, quality & outcomes · 2026Article
- Practices of Antifungal Prophylaxis Among Italian Pediatric Oncology-Hematology Centers.EJHaem · 2026Article
- Infections Within 100 Days of Idecabtagene Vicleucel and Impact on Survival for Relapsed/Refractory Multiple Myeloma: A CIBMTR Analysis.Transplantation and cellular therapy · 2026Article
- Article
- Invasive fungal disease is rare in patients with relapsed/refractory multiple myeloma treated with BCMA CAR T-cell therapy.Blood advances · 2025Article
- Schizophyllum commune infection following chimeric antigen receptor T-cell therapy in a patient with lymphoma.Journal of clinical and experimental hematopathology : JCEH · 2025Article
- Article
- Fusariosis in Patients With Hematologic Malignancies in the Era of Antifungal Prophylaxis.Transplant infectious disease : an official journal of the Transplantation SocietyArticle
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Authors and funding
18 authors.
Funding
Abstract
Patients undergoing CD19 chimeric antigen receptor (CAR)-T cell therapy exhibit multiple immune deficits that may increase their susceptibility to infections. Invasive fungal infections (IFIs) are life-threatening events in the setting of hematologic diseases. However, there is ongoing debate regarding the optimal role and duration of antifungal prophylaxis in this specific patient population. The objective of this study was to provide a comprehensive overview of the evolution of IFI prophylactic strategies over time and to assess IFI incidence rates in a cohort of patients with relapsed or refractory (R/R) lymphoma treated with CAR-T cell therapy. A single-center retrospective study was conducted on a cohort of patients with R/R B cell lymphoma treated with CD19 CAR-T cell therapy between April 2016 and March 2023. Group A (April 2016-August 2020) consisted of patients primarily treated with fluconazole, irrespective of their individual IFI risk profile. In Group B (September 2020-March 2023) antifungal prophylaxis was recommended only for high-risk patients. Overall, 330 patients were included. Antifungal prophylaxis was prescribed to 119/142 (84%) patients in Group A and 58/188 (31%) in Group B (P < .001). Anti-mold azoles were prescribed to 8 (5.6%) patients in Group A and 21 (11.2%) patients in Group B. In Group A, 42 (29%) patients were switched to another antifungal, 9 (21%) because of toxicity, with 6 cases of transaminitis and 3 cases of prolonged QTc. In Group B, 21 (11.2%) patients were switched to the antifungal drug, mainly from fluconazole or micafungin to a mold-active agent following revised guidelines. No difference was found in liver toxicity between the two groups at infusion, day 10, and day 30. No significant differences were observed between the groups. IFIs following CAR-T cell therapy were rare, with 1 case of cryptococcal meningoencephalitis in group A (.7%) and 1 case of invasive aspergillosis in Group B (.5%), both occurring in patients on micafungin prophylaxis. In this large single-center cohort of patients with R/R lymphoma treated with CAR-T cells, we show that individualized prophylaxis, alongside careful management of CAR-T cell-related toxicities such as CRS, was associated with a very low IFI rate, avoiding the risk of unnecessary toxicities, drug-drug interactions, and high costs.
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