Translating biomarker insights into practice: a path forward in TA-TMA management DOI Creative Commons
Sonata Jodele, Eleni Gavriilaki

Frontiers in Medicine, Journal Year: 2025, Volume and Issue: 12

Published: May 8, 2025

Recent advances in the management of transplant-associated thrombotic microangiopathy (TA-TMA) include harmonization diagnostic criteria and identification high-risk disease features. Individual hematologic complement biomarkers show moderate specificity when used alone detection TA-TMA hematopoietic stem cell transplant (HSCT) recipients, but endothelial injury due to microangiopathic process can be enhanced using longitudinal monitoring clinical An increase sC5b-9 level reflects terminal activation, a hallmark pathogenesis that guides therapeutic interventions. In addition, distinguishing physiologic from pathologic activation is essential for timely diagnosis selection targeted Eculizumab therapy, biomarker-guided C5 blocker, significantly improves outcomes severe TA-TMA; however, there lack knowledge on how select second-line inhibitors or combination therapies cases with suboptimal response eculizumab. This article proposes practical approaches increasing attributability by integrating clinically available supportive tests provides insights into potential currently novel inhibitors. These findings help ensure diagnosis, prevent irreversible organ injury, improve HSCT recipients TA-TMA.

Language: Английский

Invasive Fungal Disease After Chimeric Antigen Receptor-T Immunotherapy in Adult and Pediatric Patients DOI Creative Commons
Paschalis Evangelidis,

Konstantinos Tragiannidis,

Athanasios Vyzantiadis

et al.

Pathogens, Journal Year: 2025, Volume and Issue: 14(2), P. 170 - 170

Published: Feb. 8, 2025

Invasive fungal diseases (IFDs) have been documented among the causes of post-chimeric antigen receptor-T (CAR-T) cell immunotherapy complications, with incidence IFDs in CAR-T therapy recipients being measured between 0% and 10%, globally. are notorious for their potentially life-threatening nature challenging diagnosis treatment. In this review, we searched recent literature aiming to examine risk factors epidemiology post-CAR-T infusion. Moreover, role antifungal prophylaxis is investigated. especially vulnerable due several that contribute patient’s immunosuppression. Those include underlying hematological malignancies, lymphodepleting chemotherapy administered before treatment, existing leukopenia hypogammaglobinemia, use high-dose corticosteroids interleukin-6 blockers as countermeasures immune effector cell-associated neurotoxicity syndrome cytokine release syndrome, respectively. mostly occur within first 60 days following infusion T cells, but cases even a year after described. Aspergillus spp., Candida Pneumocystis jirovecii main cause these infections therapy. More real-world data regarding population essential.

Language: Английский

Citations

0
Immune Effector Cell-Associated Neurotoxicity Syndrome After CAR T-Cell Therapy and Other Psychiatric Manifestations: A Review and Case Series DOI Open Access

A.-G. Buciuc,

Sabrina Tran,

Mary Weber

et al.

Journal of Clinical Medicine, Journal Year: 2025, Volume and Issue: 14(5), P. 1451 - 1451

Published: Feb. 21, 2025

Background/Objectives: Chimeric antigen receptor (CAR) T-cell therapy has transformed the treatment of hematologic malignancies, achieving durable remissions in cases refractory to standard therapies. A potentially life-threatening complication is immune effector cell-associated neurotoxicity syndrome (ICANS), which poses significant challenges clinical management. ICANS encompasses a range neuropsychiatric symptoms, including delirium, mood disorders, psychosis, seizures, and cerebral edema. The psychiatric dimensions remain underreported, their interplay with neurologic manifestations poorly understood. This study reviews presents case series illustrating its complexity. Methods: systematic literature search was conducted using PubMed Google Scholar for studies published between 2020 2024. Search terms included “ICANS”, “delirium”, “CAR T-cell”, “neurotoxicity”, “psychiatric”. inclusion criteria English that focused on adult patients experiencing symptoms ICANS. Two prominent features are presented. Results: review found three relevant studies, emphasized agitation, hypoactivity, disturbances as often-overlooked linked highlights manifestations, irritability, cognitive impairment. Recovery supported through interventions such corticosteroid tapering, antipsychotic treatment, multidisciplinary care. Conclusions: multifaceted sequelae complicate diagnosis An enhanced recognition interdisciplinary approaches critical improving outcomes.

Language: Английский

Citations

0
Translating biomarker insights into practice: a path forward in TA-TMA management DOI Creative Commons
Sonata Jodele, Eleni Gavriilaki

Frontiers in Medicine, Journal Year: 2025, Volume and Issue: 12

Published: May 8, 2025

Recent advances in the management of transplant-associated thrombotic microangiopathy (TA-TMA) include harmonization diagnostic criteria and identification high-risk disease features. Individual hematologic complement biomarkers show moderate specificity when used alone detection TA-TMA hematopoietic stem cell transplant (HSCT) recipients, but endothelial injury due to microangiopathic process can be enhanced using longitudinal monitoring clinical An increase sC5b-9 level reflects terminal activation, a hallmark pathogenesis that guides therapeutic interventions. In addition, distinguishing physiologic from pathologic activation is essential for timely diagnosis selection targeted Eculizumab therapy, biomarker-guided C5 blocker, significantly improves outcomes severe TA-TMA; however, there lack knowledge on how select second-line inhibitors or combination therapies cases with suboptimal response eculizumab. This article proposes practical approaches increasing attributability by integrating clinically available supportive tests provides insights into potential currently novel inhibitors. These findings help ensure diagnosis, prevent irreversible organ injury, improve HSCT recipients TA-TMA.

Language: Английский

Citations

0