Managing hypogammaglobulinemia in patients treated with CAR-T-cell therapy: key points for clinicians.
Eleftheria KampouriCarla S WaltiJordan GauthierJoshua A HillPublished in: Expert review of hematology (2022)
CD19 and BCMA CAR-T-cell therapy result in unique immune deficits due to depletion of specific B-lineage cells and may require different infection prevention strategies. Hypogammaglobulinemia before and after CAR-T-cell therapy is frequent, but data on the efficacy and cost-effectiveness of IGRT are lacking. Monthly IGRT should be prioritized for patients with severe or recurrent bacterial infections. IGRT may be more broadly necessary to prevent infections in BCMA-CAR-T-cell recipients and children with severe hypogammaglobulinemia irrespective of infection history. Vaccinations are indicated to augment humoral immunity and can be immunogenic despite cytopenias; re-vaccination(s) may be required. Controlled trials are needed to better understand the role of IGRT and vaccines in this population.
Keyphrases
- cell therapy
- stem cells
- mesenchymal stem cells
- induced apoptosis
- early onset
- immune response
- traumatic brain injury
- young adults
- cell cycle arrest
- palliative care
- electronic health record
- big data
- signaling pathway
- endoplasmic reticulum stress
- oxidative stress
- machine learning
- kidney transplantation
- artificial intelligence
- deep learning
- pi k akt