TABLE 1.
Summary of presented case characteristics
| Case 1 | Case 2 | Case 3 | ||
|---|---|---|---|---|
| Demographics | Infection onset in relation to CRS (day 1st positive culture) | Concurrent with CRS onset (day +7) | After CRS resolution (day +19) | After CRS resolution (day +24) |
| Age/Sex | 4-Year-old male | 18-Year-old female | 26-Year-old male | |
| Relevant past medical history | Prior infectious disease complications | N/A | Clostridium difficile typhlitis bacteremia with septic shock | N/A |
| Most recent line of therapy | TACL 2017–002a (day −44) | Vincristine (day −40) | Vincristine (day −12) | |
| Relapsed vs. refractory (previous lines of therapy) | Refractory (2) | Relapsed (4) | Relapsed (2) | |
| Prior CAR T-cell therapy | Yes (CD19) | No | No | |
| Prior HSCT | No | Yes (MUD) | No | |
| Steroids in month prior to CAR | No | Yes | Yes | |
| ANC at lymphodepletion start | 370/μl | 7420/μl | 13,120/μl | |
| Hg at lymphodepletion start (days since pRBC transfusion) | 9.4 g/dl (8) | 10.7 g/dl (1) | 9.9 g/dl (16) | |
| Plt at lymphodepletion start (days since platelet transfusion) | 264,000/μl (NA) | 189,000/μl (17) | 228,000/μl (NA) | |
| Infectious disease | Antibiotic at the time of infectionb | Piperacillin/tazobactam (initiated with febrile neutropenia following CAR T-cell infusion) | Metronidazole (C. difficile prophylaxis) | Ciprofloxacin |
| ANC at the time of infection | N/Ac | 1020/μl | N/Ac | |
| Hg at time of infection (days since prior pRBC transfusion) | 10.4 g/dl (2) | 8.4 g/dl (6) | 8.6 g/dl (1) | |
| Plt at time of infection (days since prior platelet transfusion) | 167,000/μl (NA) | 53,000/μl (1) | 13,000/μl (2) | |
| Organism(s) by blood Cx | Bacillus cereus | Enterobacter clocae | Staphylococcus epidermidis Weeksella virosa | |
| Empiric antibiotics (organism sensitive?) | Meropenem + vancomycin (Y) | Ceftazidime + amphotericin (N) → transition to meropenem within 12 hours (Y) | Meropenem + linezolid + amphotericin + posaconazole (Y) | |
| CAR toxicities | CRS, max grade (onset) | 2 (day +7) | 3 (day +8) | 3 (day +4) |
| Peak ferritin (ng/ml) (day) | 349,750 (day+11) | 590,100 (day+17) | 271,600 (day+10) | |
| Clinical outcomes | Brief description | CR, but unable to proceed to HSCT; died from PD | Died from complications of sepsis | Achieved CR and proceeded to HSCTd |
Abbreviations: ANC, absolute neutrophil count; CAR, chimeric antigen receptor; CRS, cytokine release syndrome; Hg, hemoglobin; HSCT, hematopoietic stem cell transplant; plt, platelet count; pRBC, packed red blood cells; MUD: matched unrelated donor
a
TACL 2017–002 (ixazomib, vincristine, doxorubicin, pegasparaginase, dexamethasone, and intrathecal methotrexate).
b
All patients on prophylactic acyclovir, micafungin, and pentamidine.
c
Differential not completed (total white blood cell count too low to complete differential).
d
Patient ultimately died from complications of treatment of post-HSCT relapse).