5 research outputs found
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Progressive multifocal leukoencephalopathy after CAR T therapy
Progressive multifocal leukoencephalopathy (PML) remains a life-threatening central nervous system infection in immunocompromised patients. Although outcomes have improved in cases that immune reconstitution is feasible with anti-retroviral therapy (ART) in HIV + patients or natalizumab removal in those with multiple sclerosis, in individuals with hematological malignancies, the prognosis is usually dismal. Anti-viral treatments have been largely ineffective, but immunotherapy-based approaches with checkpoint inhibitors and adoptive virus-specific T cells' transfer are currently explored in clinical trials. PML has not been described as a cause of encephalopathy after CAR T therapy. We report the first case of PML 7 months after lymphodepleting chemotherapy with fludarabine/cyclophosphamide and anti-CD19-directed CAR T therapy in a patient with relapsed diffuse large B-cell lymphoma who relapsed fast after a previous autologous hematopoietic stem cell transplant. She remains alive 12 months after diagnosis with stabilization of her symptoms with a combination of therapies targeting viral replication and immunotherapy
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Aseptic Meningitis after Recovery from SARS-CoV-2 in an Allogeneic Stem Cell Transplant Recipient
SARS-CoV-2 emerged as a worldwide pandemic in late 2019 and initially was described as a primary respiratory illness. The clinical manifestations of COVID-19 are now known to encompass nearly all organ systems, including the central nervous system. We present a case of an allogeneic hematopoietic stem cell transplant recipient who recovered from documented SARS-CoV-2 infection and later presented with symptoms of meningitis. While cerebrospinal fluid analysis did not reveal any bacterial or viral etiologies, evidence of an inflammatory state, including ophthalmologic findings of episcleritis, indicate what is likely the first reported case of aseptic meningitis associated with SARS-CoV-2 infection after initial clinical recovery
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Catheter Complications in Patients Undergoing Extracorporeal Photopheresis for Management of Graft-Versus-Host Disease
Complications associated with central vascular access (VA) in patients (pts) undergoing extracorporeal photopheresis (ECP) may limit therapy. VA options often include dual lumen vortex (DLV) implantable and tunneled trifusion/other (TF) catheters. There is limited data about VA associated complications such as infection, thrombosis, and equipment failure in those undergoing ECP.
Our primary aim was to describe VA associated complications during ECP.
We retrospectively reviewed pts who received ECP at our institution from January 2011 to October 2019. We examined episodes of cellulitis, catheter associated bacterial infection (CLABSI), catheter removal/exchange (CRE), and discontinuation of ECP.
Fifty-two pts had at least 4 ECP sessions using VA. 12 were treated for acute and 40 for chronic/overlap GvHD (cGvHD). Overall, median # ECP sessions (ES) was 35 (range 4-311), median # ECP months (EM) was 7 (range 0.5 to 86). Total number of VA events = 21.
In cGvHD (n=40), Median ES was 50 (range 14-311). With DLV catheters (16/40 pts), total VA events = 8 (1 event every 133 ES). 5 events required CRE, and 3 pts resumed ECP after event. With TF catheters (24/40 pts), total VA events = 8 (1 event every 142 ES). 2 events required CRE, and 4 pts restarted ECP after event.
In acute GVHD (n=12), median ES was 15 (range 4-83). 11/12 used a TF catheter. CLABSI was diagnosed in 5/12 pts, all of whom were already hospitalized for GvHD therapy. 3/5 required CRE. ECP was discontinued in all events due to progressive GvHD or infection.
During ECP for cGvHD treatment, DLV and TF catheters have similar number of complications (p=0.81) when adjusted for total ES and EM. VA events are a major cause of ECP discontinuation. In aGvHD, the high incidence of CLABSI is attributed to severe immunosuppression from therapy rather than specific catheter related events
Successful Treatment of Disseminated Disease Due to Highly Resistant Aspergillus calidoustus with a Novel Antifungal Therapy
Invasive aspergillosis is the most common invasive mold infection following a hematopoietic cell transplant. Widespread use of antifungal prophylaxis has led to the increasing incidence of cryptic Aspergillus species. Aspergillus calidoustus is one of those emerging species and is notorious for multidrug resistance to antifungals. Here, we report a case of disseminated A. calidoustus infection in a hematopoietic stem cell transplant recipient who was successfully treated with combination therapy that included a novel antifungal.
Invasive aspergillosis is the most common invasive mold infection following a hematopoietic cell transplant. Widespread use of antifungal prophylaxis has led to the increasing incidence of cryptic Aspergillus species. Aspergillus calidoustus is one of those emerging species and is notorious for multidrug resistance to antifungals