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Progressive Multifocal Leukoencephalopathy After Chimeric Antigen Receptor T-Cell Therapy for Recurrent Non-Hodgkin Lymphoma
Chimeric antigen receptor (CAR) T-cell therapy targeting cluster of differentiation (CD)19 has had a transformative impact on patient outcomes in a subset of patients with relapsed/refractory non-Hodgkin lymphoma. We present a patient with refractory large B-cell lymphoma in complete remission for 2...
Autores principales: | , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Elmer Press
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8577592/ https://www.ncbi.nlm.nih.gov/pubmed/34804310 http://dx.doi.org/10.14740/jh903 |
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author | Ahrendsen, Jared T. Sehgal, Kartik Sarangi, Sasmit Uhlmann, Erik J. Varma, Hemant Arnason, Jon Avigan, David |
author_facet | Ahrendsen, Jared T. Sehgal, Kartik Sarangi, Sasmit Uhlmann, Erik J. Varma, Hemant Arnason, Jon Avigan, David |
author_sort | Ahrendsen, Jared T. |
collection | PubMed |
description | Chimeric antigen receptor (CAR) T-cell therapy targeting cluster of differentiation (CD)19 has had a transformative impact on patient outcomes in a subset of patients with relapsed/refractory non-Hodgkin lymphoma. We present a patient with refractory large B-cell lymphoma in complete remission for 2 years following treatment with CD19-targeted CAR T-cell therapy, who presented with 2 weeks of progressive aphasia. Imaging revealed a left occipital brain lesion and biopsy demonstrated features diagnostic of progressive multifocal leukoencephalopathy. Further evaluation revealed severe hypogammaglobulinemia and a low CD4 count. She was treated with pembrolizumab and intravenous immunoglobulin resulting in decreased cerebrospinal fluid viral load without clinical improvement and died 8 weeks after presentation. This case highlights that there is potential for severe opportunistic infections after CAR T-cell therapy, including fatal progressive multifocal leukoencephalopathy. Strategies to enhance post-treatment immune reconstitution are essential to further harness the unique potency of CAR T-cell therapy. |
format | Online Article Text |
id | pubmed-8577592 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | Elmer Press |
record_format | MEDLINE/PubMed |
spelling | pubmed-85775922021-11-18 Progressive Multifocal Leukoencephalopathy After Chimeric Antigen Receptor T-Cell Therapy for Recurrent Non-Hodgkin Lymphoma Ahrendsen, Jared T. Sehgal, Kartik Sarangi, Sasmit Uhlmann, Erik J. Varma, Hemant Arnason, Jon Avigan, David J Hematol Case Report Chimeric antigen receptor (CAR) T-cell therapy targeting cluster of differentiation (CD)19 has had a transformative impact on patient outcomes in a subset of patients with relapsed/refractory non-Hodgkin lymphoma. We present a patient with refractory large B-cell lymphoma in complete remission for 2 years following treatment with CD19-targeted CAR T-cell therapy, who presented with 2 weeks of progressive aphasia. Imaging revealed a left occipital brain lesion and biopsy demonstrated features diagnostic of progressive multifocal leukoencephalopathy. Further evaluation revealed severe hypogammaglobulinemia and a low CD4 count. She was treated with pembrolizumab and intravenous immunoglobulin resulting in decreased cerebrospinal fluid viral load without clinical improvement and died 8 weeks after presentation. This case highlights that there is potential for severe opportunistic infections after CAR T-cell therapy, including fatal progressive multifocal leukoencephalopathy. Strategies to enhance post-treatment immune reconstitution are essential to further harness the unique potency of CAR T-cell therapy. Elmer Press 2021-10 2021-10-05 /pmc/articles/PMC8577592/ /pubmed/34804310 http://dx.doi.org/10.14740/jh903 Text en Copyright 2021, Ahrendsen et al. https://creativecommons.org/licenses/by-nc/4.0/This article is distributed under the terms of the Creative Commons Attribution Non-Commercial 4.0 International License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. |
spellingShingle | Case Report Ahrendsen, Jared T. Sehgal, Kartik Sarangi, Sasmit Uhlmann, Erik J. Varma, Hemant Arnason, Jon Avigan, David Progressive Multifocal Leukoencephalopathy After Chimeric Antigen Receptor T-Cell Therapy for Recurrent Non-Hodgkin Lymphoma |
title | Progressive Multifocal Leukoencephalopathy After Chimeric Antigen Receptor T-Cell Therapy for Recurrent Non-Hodgkin Lymphoma |
title_full | Progressive Multifocal Leukoencephalopathy After Chimeric Antigen Receptor T-Cell Therapy for Recurrent Non-Hodgkin Lymphoma |
title_fullStr | Progressive Multifocal Leukoencephalopathy After Chimeric Antigen Receptor T-Cell Therapy for Recurrent Non-Hodgkin Lymphoma |
title_full_unstemmed | Progressive Multifocal Leukoencephalopathy After Chimeric Antigen Receptor T-Cell Therapy for Recurrent Non-Hodgkin Lymphoma |
title_short | Progressive Multifocal Leukoencephalopathy After Chimeric Antigen Receptor T-Cell Therapy for Recurrent Non-Hodgkin Lymphoma |
title_sort | progressive multifocal leukoencephalopathy after chimeric antigen receptor t-cell therapy for recurrent non-hodgkin lymphoma |
topic | Case Report |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8577592/ https://www.ncbi.nlm.nih.gov/pubmed/34804310 http://dx.doi.org/10.14740/jh903 |
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