non-Hodgkin Research Articles

A Kikuchi-fujimoto Syndrome in the Pocket of a Non-hodking Lymphoma: Case Report With a Mini-review of the Literature

Introduction: Kikuchi-Fujimoto disease is a rare, benign necrotizing lymphadenitis primarily affecting young women. Case presentation: We present the case of a 26-year-old female patient with no notable medical history, who developed a persistent right-sided lateral cervical lymphadenopathy over a two-month period. Following a comprehensive clinical, laboratory, radiological, and histopathological evaluation, a diagnosis of Kikuchi-Fujimoto disease was confirmed. Given the rarity of this condition, clinicians should maintain a high index of suspicion to avoid misdiagnosis or delayed recognition. Clinical discussion: Kikuchi-Fujimoto disease is a rare, It presents as febrile cervical lymphadenopathy and may be associated with systemic lupus erythematosus. Often mistaken for conditions such as non-Hodgkin lymphoma, its diagnosis relies on histopathological examination. Lymph node biopsy is crucial to prevent unnecessary investigations. The prognosis is generally favorable, with treatment commonly involving corticosteroids. Conclusion: While the prognosis for KFD is generally favorable, around 30% of sufferers may go on to develop systemic lupus erythematosus, underlining the need for ongoing monitoring of autoimmune markers

Predicting response to initial chemotherapy in pediatric lymphoma using a semiquantitative contrast enhanced CT (CECT)-based abdomino-thoracic score: a pilot prospective observational study.

There is a lack of staging systems in pediatric lymphoma to quantify the burden of the disease based on the anatomical extent of lymph nodal distribution. To evaluate the utility of a CECT-based semiquantitative lymph nodal scoring system in predicting histopathological type of childhood lymphoma and response to initial chemotherapy. Pre-treatment CECT of abdomen and thorax was performed in children with lymphoma and a Checklist-based reporting template was used to report the lymph nodal involvement. Based on the distribution of lymph nodes, a semi-quantitative scoring system was developed to cover all the locations of thorax and abdomen. Anatomical semiquantitative scoring was done for thorax (score 0-10), abdomen (scores 0-10), and a combined thoraco-abdominal score (0-20) was calculated. Also, the mean scores were compared in patients with complete response(CR) and Non-complete response(NCR) to primary treatment. Decrease in size of all the pathological nodes to < 10mm in short axis and < 15mm in long axis was defined as CR. Fifty patients were included with 35 cases of Hodgkin Lymphoma(HL) and 15 cases of Non-Hodgkin Lymphoma(NHL). Mean abdominal, thoracic, and combined lymph nodal scores were significantly lower in the pre-treatment scan in children with HL (3.5 ± 2.3, 3.3 ± 1.75,and6.89 ± 3.54) compared to NHL (4.8 ± 2.1,5.2 ± 2.8,and10.0 ± 3.96). The mean abdominal, thoracic, and combined lymph nodal scores in the pre-treatment scan was significantly higher in NCR group. The lymph nodal burden, estimated by semiquantitative abdominal and thoracic scores is significantly higher in lymphoma patients with non-complete response.

Intravascular Large B-Cell Lymphoma With Exclusively Cutaneous Involvement, Colonizing Pre-Existing Hemangiomas: A Rare Case With Aberrant HMB45 Expression.

Intravascular large B-cell lymphoma (IVLBCL) is a rare and aggressive subtype of non-Hodgkin lymphoma. It is characterized by the presence of neoplastic lymphoid cells within blood vessels. We report a rare case of IVLBCL with exclusively cutaneous involvement colonization of hemangiomas. A 55-year-old man with a history of cutaneous angioma consulted dermatology because of the growth of some of the hemangiomas in recent months. Histologic examination revealed a dermal proliferation of small- and medium-sized vessels with lumina occupied by large pleomorphic cells with B immunophenotype and aberrant expression of HMB-45. Biopsy of a pre-existing hemangioma may be useful in the diagnosis of suspected cutaneous IVLBCL. The cutaneous variant has a better prognosis. It is also important to note that unexpected protein expression or loss of expression in malignant tumors may be a risk factor for misdiagnosis.

Cost drivers associated with autologous stem-cell transplant (ASCT) in patients with relapsed/refractory diffuse large B-cell lymphoma in a Japanese real-world setting: A structural equation model (SEM) analysis 2012–2022

Diffuse large B-cell lymphoma (DLBCL) is the most prevalent non-Hodgkin lymphoma, with increasing incidence, in Japan. It is associated with substantial economic burden and relatively poor survival outcomes for relapsed/ refractory (r/r) DLBCL patients. Despite its association with economic burden and the relatively limited number of eligible patients in Japan as reported in previous real-world studies, Japanese clinical guidelines recommend stem-cell transplantation (SCT) for transplant-eligible r/r DLBCL patients. This is the first study to elucidate the total healthcare cost, associated cost drivers and healthcare resource use of SCT among patients with r/r DLBCL in a nationwide setting. The study design included a follow-up period of up to 24 months with subsequent lines of therapies using retrospective nationwide claims data from the Medical Data Vision Co., Ltd. Health Insurance Association from April 2012 to August 2022. Included patients had a confirmed diagnosis of DLBCL, received allogeneic SCT (allo-SCT) or autologous SCT (ASCT) after the first DLBCL diagnosis, and received high-dose chemotherapy during the 6-month look-back period. The results confirmed that no patients had allo-SCT, hence only ASCT was included in the analysis. Structural equation modeling was used to identify potential total healthcare cost drivers by evaluating direct, indirect, and total effects and provide a benchmark reference for future innovative therapies. A total of 108 patients (3.8%) among all DLBCL patients who received SCT met the eligibility criteria and were considered ASCT patients; majority of which were males (n = 63, 58.33%), with a mean [median] (SD) age of 52.04 [55] (9.88) years. A total of 15 patients (13.89%) received subsequent therapies. The most frequent subsequent therapy was GDP-based with or without rituximab (n = 8, 7.41%). The mean [median] (SD) number of follow-up hospitalizations on or after SCT-related hospitalizations was 1.66 [1] (1.36), with a mean [median] (SD) length of hospital stay being 36.88 [34] (12.95) days. The total mean [median] (SD) healthcare cost after adjustment incurred per patient per year during follow-up was $79,052.44 [$42,722.82] ($121,503.65). Number of hospitalizations and Charlson Comorbidity Index scores (+5) were the key drivers of total healthcare costs in patients with r/r DLBCL. Index years 2020–2022 and heart disease as a complication were other statistically significant factors that had positive effects as increase on total healthcare costs.

Non-Hodgkin Lymphoma Manifesting as Bilateral Tonsillar Hypertrophy: A Case Report

Non-Hodgkin Lymphoma Manifesting as Bilateral Tonsillar Hypertrophy: A Case Report

Factors Influencing Chemotherapy-Induced Nausea, Vomiting, and Alterations in Taste in Patients with Non-Hodgkin Lymphoma

Factors Influencing Chemotherapy-Induced Nausea, Vomiting, and Alterations in Taste in Patients with Non-Hodgkin Lymphoma

Primary Breast Lymphoma in a Young Female: Non-Hodgkin's Diffuse Large B-Cell Lymphoma in the Presence of Intact Breast Prostheses

Breast implants are among the most frequently used medical devices for aesthetic and reconstructive purposes. We present A 24-year-old female with a growing breast mass was diagnosed with Primary Breast Lymphoma (Non-Hodgkin's Diffuse Large B-Cell Lymphoma). She underwent successful R-CHOP chemotherapy, resulting in complete remission. Follow-up imaging showed no distant metastasis or significant residual disease, with silicone implants intact and no pathological uptake.

Actinomycosis: Mimicking Malignancies in Multiple Anatomical Sites—A Three-Patient Case Series

Background and Objectives: Actinomycosis is a rare chronic contagion caused by Actinomyces spp. known for its ability to mimic malignant processes across various anatomical locations. Its clinical presentation can often resemble malignancies, Mycobacterium tuberculosis infections, nocardiosis, fungal infections, or other granulomatous diseases. This case series presents three patients diagnosed with Actinomyces spp., highlighting the diagnostic challenges and diverse clinical manifestations of the disease. Materials and Methods: We reviewed the clinical course, diagnostic procedures, and treatment outcomes of three patients with confirmed Actinomyces spp. The first case involved a 51-year-old male with a history of rhabdomyosarcoma in remission who presented with dysphagia. Magnetic resonance imaging identified an irregularly enhancing mass in the tonsil, and subsequent tonsillectomy confirmed Actinomyces spp. The second patient, an 80-year-old female, presented with dysphagia and a sublingual mass initially suspected to be diffuse large B-cell non-Hodgkin lymphoma; however, a histopathological analysis confirmed Actinomyces spp. The third case involved a 72-year-old male with abdominal pain and an ulcerated gastric lesion, where subtotal gastrectomy and histopathological examination confirmed the diagnosis of Actinomyces spp. Results: These three cases highlight the ability of Actinomyces spp. to closely mimic malignant lesions, which significantly complicates the diagnostic process. Although personalized interventions were required for each patient, diagnoses were ultimately confirmed through histopathology. Despite these challenges, timely recognition and appropriate treatment were achieved, underscoring the need to consider Actinomyces spp. in the differential diagnosis of similar presentations. Conclusions:Actinomyces spp. remains a diagnostic challenge due to its ability to mimic a variety of malignant and contagion conditions. This case series emphasizes the need for a thorough histopathological examination and a high index of suspicion when encountering lesions with atypical presentations. Given the potential for misdiagnosis, awareness and consideration of Actinomyces spp. are crucial in the differential diagnosis of chronic contagion and mass lesions. Further studies are warranted to refine diagnostic and therapeutic approaches.

Prenatal exposure to per- and polyfluoroalkyl substances (PFAS) from contaminated water and risk of childhood cancer in California, 2000-2015.

Few studies have investigated associations between per- and polyfluoroalkyl substances (PFAS) and childhood cancers. Detectable levels of PFAS in California water districts were reported in the Third Unregulated Contaminant Monitoring Rule for 2013-2015. Geocoded residences at birth were linked to corresponding water district boundaries for 10,220 California-born children (aged 0-15 years) diagnosed with cancers (2000-2015) and 29,974 healthy controls. A pharmacokinetic model was used to predict average steady-state maternal serum concentrations of perfluorooctanesulfonic acid (PFOS) and perfluorooctanoic acid (PFOA) from contaminated drinking water. Adjusted odds ratios (AORs) and 95% confidence intervals (CIs) per doubling of background exposure were calculated for cancers with at least 90 cases. Predicted PFOS and PFOA maternal serum concentrations ranged from background (5 ng/ml PFOS and 2 ng/ml PFOA) to 22.89 ng/ml and 6.66 ng/ml, respectively. There were suggestive associations between PFOS and nonastrocytoma gliomas (n = 268; AOR = 1.26; 95% CI: 0.99, 1.60), acute myeloid leukemia (n = 500; AOR = 1.14; 95% CI: 0.94, 1.39), Wilms tumors (n = 556, AOR = 1.15; 95% CI: 0.96, 1.38), and noncentral system embryonal tumors (n = 2,880; AOR = 1.07; 95% CI: 0.98, 1.17), and between PFOA and non-Hodgkin lymphoma (n = 384; AOR = 1.19; 95% CI: 0.95, 1.49). Among children of Mexico-born mothers, there was increased risk of Wilms tumor (n = 101; AORPFOS = 1.52; 95% CI: 1.06, 2.18; AORPFOA = 1.59, 95% CI: 1.12, 2.24) and noncentral system embryonal tumors (n = 557; AORPFOS = 1.24, 95% CI: 1.03, 1.50; AORPFOA = 1.19, 95% CI: 0.98, 1.45). Results suggest associations between predicted prenatal maternal PFAS serum concentrations and some childhood cancers. Future analyses are warranted.

Measuring healthy life expectancy and determinants of poor perceived health: A population-based study among a subset of rare and common cancer survivors.

As the survival proportions for rare cancers are on average worse than for common cancers, assessing the expected remaining life years in good health becomes highly relevant. This study aimed to estimate the healthy life expectancy (HLE) of a subset of rare and common cancer survivors, and to assess the determinants of poor perceived health in rare cancer survivors. To calculate HLE, survival data from the population-based Netherlands Cancer Registry of survivors of a rare cancer (i.e., ovarian cancer, thyroid cancer, Hodgkin lymphoma, non-Hodgkin lymphoma) (n=21,376) and a common cancer (i.e., colorectal cancer (CRC)) (n=76,949) were combined with quality of life (QoL) data from the PROFILES registry on a random sample of the rare (n=1025) and common cancer (n=2400) survivors. A flexible parametric relative survival model was used to estimate life expectancy (LE) and years of life lost, and multivariate logistic regression was applied to determine factors related to reported poor perceived health. Patients previously diagnosed with a rare cancer had an average LE of 8-36 years and were expected to spend ≥67 % of their remaining life in good health. CRC survivors had an average LE of 10 years with approximately 65 % of their remaining life expected to spend in good health. For all cancer types, those aged ≥65 years or with stage IV had the lowest HLE. Low socioeconomic status, advanced stage, and having received radiotherapy only were important predictors of poor perceived health among rare cancer survivors. HLE can provide meaningful perspective for patients and practitioners for all cancer types, including rare cancers. Yet, data on QoL for rare cancers should be routinely collected, as such will serve as an indicator for monitoring and improving cancer care, and for enabling HLE measurements in cancer survivors.

Pediatric Lymphomas: Key Concepts and Clinical Approaches for Pediatricians.

Lymphomas are the third most prevalent pediatric cancer following leukemia and brain tumors, representing 10% to15% of all childhood cancers. We can divide lymphomas into Hodgkin and non-Hodgkin lymphomas, with marked differences between these 2 groups. Clinical manifestations can be insidious, and clinicians should have a high index of suspicion when treating patients with lymphadenopathies, weight loss, or prolonged fever. Although refinements in chemotherapy regimens have improved survival for pediatric lymphomas, more recent successful incorporation of targeted therapies offers hope for even better outcomes with fewer late effects. Given the excellent prognosis for many of these patients, it is increasingly important for primary care physicians to recognize and manage potential late effects of therapy, both physical and psychological.

Silicone breast implant-associated pathologies and T cell-mediated responses.

Silicone breast implants elicit a foreign body response (FBR) defined by a complex cascade of various immune cells. Studies have shown that the capsule around silicone breast implants that forms as a result of the FBR contains large T cell populations. T cells are implicated in pathologies such as capsular contracture, which is defined by an excessively fibrotic capsule, and breast implant-associated anaplastic large cell lymphoma (BIA-ALCL), a non-Hodgkin's lymphoma. In this article, we provide a synthesis of 17 studies reporting on T cell-mediated responses to silicone breast implants and highlight recent developments on this topic. The lymphocytes present in the breast implant capsule are predominantly Th1 and Th17 cells. Patients with advanced capsular contracture had fewer T-regulatory (Treg) cells present in the capsules that were less able to suppress T effector cells such as Th17 cells, which can promote fibrosis in autoimmune conditions. Textured silicone implants, which are associated with BIA-ALCL, created a more robust T cell response, especially CD30 + T cells in the peri-implant fluid and CD4 + T cells in the capsule. Cultivating a deeper understanding of T cell-mediated responses to silicone breast implants may allow for novel treatments of breast implant-associated complications and malignancies.

Molecular Mechanisms and Therapeutic Prospects of Immunotherapy and Targeted Therapy in Primary Central Nervous System Lymphoma.

Primary central nervous system lymphoma (PCNSL) is a very rare extranodal non-Hodgkin's lymphoma confined to the brain, eyes, spinal cord, and cerebrospinal fluid (CSF). This disease is highly aggressive. For decades, high-dose methotrexate-based induction regimens have been the standard treatment for PCNSL and have significantly improved patient overall survival (OS). However, some patients still experience disease recurrence or develop drug resistance. With a deeper understanding of the pathophysiology of PCNSL, various therapies, including CD20 monoclonal antibodies, Bruton's tyrosine kinase (BTK) inhibitors, immunomodulatory drugs, immune checkpoint inhibitors, phosphoinositide 3-kinase (PI3 K)/mammalian target of rapamycin(mTOR) inhibitors, and chimeric antigen receptor (CAR) -T cells are increasingly being applied and have demonstrated considerable efficacy. These therapies have paved the way for novel treatment strategies in PCNSL, representing a highly promising field. Investigating the mechanisms, specific targets, and signaling pathways, as well as interactions with the tumor microenvironment (TME), can provide a solid foundation for further exploration and potentially enhance the optimization of treatment approaches for PCNSL. This review seeks to explore the characteristics of the TME in PCNSL, elucidate the molecular mechanisms of various immunotherapies and targeted therapies, examine their interactions with the TME, and summarize the advancements in the research of PCNSL immunotherapy and targeted therapy.

Advances in the Pathogenesis, Diagnosis, Treatment, and Prognosis of Marginal Zone Lymphoma.

The management of marginal zone lymphoma (MZL), an indolent B-cell non-Hodgkin lymphoma, requires a personalized and adaptive approach due to its clinical and prognostic heterogeneity. We believe treatment should emphasize a balanced strategy considering the subtype, disease burden, symptoms, and actionable genetic or environmental factors, such as infections or autoimmune diseases. For asymptomatic patients with low tumor burden or disseminated disease, a watch-and-wait approach remains appropriate, given MZL's indolent nature and the risks of overtreatment. Conversely, for symptomatic or high-burden cases, early intervention with chemoimmunotherapy is recommended for effective disease control. Surgery remains essential for both diagnosis and the treatment of localized disease. Incorporating molecular profiling and prognostic models, such as MZL-IPI and POD24, is crucial for decision-making and risk stratification. Testing for infectious agents like Helicobacter pylori or Hepatitis C virus should be standard practice, as eradication therapy offers a targeted, less toxic, and effective option in select patients. With ongoing advancements in understanding dysregulated signaling pathways and the tumor microenvironment, we anticipate novel targeted therapies and combination regimens will further improve outcomes. We advocate for molecular testing at diagnosis to identify actionable biomarkers, particularly for patients with refractory or relapsed disease. Finally, MZL management requires vigilant follow-up with adjustments based on evolving disease features. Treatment decisions should integrate patient preferences, clinical context, and the latest evidence to maximize survival while preserving quality of life.

Comparison of differences in transcriptional and genetic profiles between intra-central nervous system and extra-central nervous system large B-cell lymphoma.

Primary central nervous system diffused large B-cell lymphoma (PCNS-DLBCL) is a rare type of non-Hodgkin lymphoma restricted to the central nervous system (CNS). To explore its specific pathogenesis and therapeutic targets, we performed multi-omics sequencing on tumor samples from patients diagnosed with PCNS-DLBCL, secondary CNS-DLBCL or extracranial (ec) DLBCL.By single-cell RNA sequencing, highly proliferated and dark zone (DZ)-related B cell subclusters, MKI67_B1, PTTG1_B2 and BTG1_B3, were predominant significantly in PCNS-DLBCL. Compared to SCNS-DLBCL and ecDLBCL, an immune-suppressive tumor microenvironment was observed in PCNS-DLBCL by analysis of immune-stimulating/inhibitory ligand‒receptor (L-R) pairs. By performing whole-exome sequencing in 93 patients, mutations enriched in BCR-NFkB and TLR pathways and the cooperation of these two pathways were found to be predominant in PCNS-DLBCL comparing to nonGCB-ecDLBCL. In summary, our study provides comprehensive insights into the transcriptomic and genetic characteristics of PCNS-DLBCL in contrast to ecDLBCL and will help dissect the oncogenic mechanism of this disease.

FCRL1 and BAFF mRNA Expression as Novel Diagnostic and Prognostic Biomarkers in Diffuse Large B-Cell Lymphoma: Expression Signatures Predict R-CHOP Therapy Response and Survival

This study investigated the diagnostic, prognostic, and therapeutic significance of Fc receptor-like 1 (FCRL1) and B-cell activating factor (BAFF) mRNA expression in Egyptian patients with diffuse large B-cell lymphoma (DLBCL) undergoing the standard R-CHOP regimen (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone) using quantitative real-time PCR (RT-qPCR). The results demonstrated that FCRL1 and BAFF mRNA expression were significantly elevated in DLBCL patients compared to healthy controls. A strong positive correlation existed between BAFF and FCRL1 expression levels. Diagnostic performance assessed through combined ROC curve analysis revealed that BAFF, FCRL1, and lactate dehydrogenase (LDH) achieved perfect diagnostic accuracy (AUC = 1.0), demonstrating 100% sensitivity, specificity, and predictive values. Further prognostic analysis using COX regression identified elevated FCRL1 expression as the most significant predictor of poor clinical outcomes. Kaplan–Meier survival analysis reinforced this finding, with high FCRL1 expression showing significant associations with reduced overall survival (OS, p = 0.031) and progression-free survival (PFS, p = 0.038). The study underscores the potential utility of BAFF and FCRL1 mRNA as diagnostic markers for DLBCL, with FCRL1 emerging as a promising prognostic marker and potential therapeutic target enabling more tailored treatment approaches for DLBCL, the most common type of B-cell non-Hodgkin lymphoma, and patients receiving R-CHOP therapy.

Primary non-Hodgkin lymphoma of the palatine tonsil: Case report and review of the literature

Primary non-Hodgkin lymphoma of the palatine tonsil: Case report and review of the literature

Primary lymphoma of bone in a 60-year-old diabetic patient: a case report

In this report, we discuss an atypical case of bone pain caused by primary lymphoma of bone. A 60-year-old, diabetic, normotensive male presented with constant, unremitting pain in different bones. X-ray showed lytic lesion and fine needle aspiration cytology from the bone revealed non-Hodgkin lymphoma. Due low prevalence, primary bone lymphoma is often diagnosed late. BIRDEM Med J 2025; 15(1): 47-50

P-2272. The CARV challenge: How do hematological malignancy patients struggle with diverse CARV pathogens

Abstract Background With growing concerns about the effects of community-acquired respiratory viruses (CARVs) on hematological malignancy patients, proactive measures are necessary to minimize risks and improve treatment results. This study aimed to collect and analyze epidemiological, management, and outcome data from these patients with CARV infections to develop customized clinical management approaches.Table 1.Patient characterisitics Methods Utilizing an online registry, data from of CARV infections in hematological malignancy patients were collected from January 2023 to January 2024, spanning 53 sites across 21 countries. Results Our survey included 561 cases of CARV in hematological malignancy patients, with a majority from Italy (39%) and Spain (19%). Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) made up 63% of cases, followed by influenza (15%), respiratory syncytial virus (12%), and rhinovirus (9%). The distribution of CARVs mirrored the overall prevalence across different malignancies, with 27% in acute leukemias and non-Hodgkin lymphoma each, and 21% in multiple myeloma. Stem cell transplantation or CAR-T therapy preceded CARV infection in 24% of patients, particularly with metapneumovirus (67%) and parainfluenza (60%). Chronic cardiopathies were the most common comorbidity (41%). Critical illness was more prevalent in metapneumovirus (22%) and influenza cases (18%) compared to RSV (11%) or SARS-CoV-2 (8%). Metapneumovirus and parainfluenza had the highest mortality rates (33% and 30%, respectively), surpassing those of influenza (16%) or SARS-CoV-2 (11%). SARS-CoV-2 (68%) and RSV (50%) had the highest associated mortality rates. Progression of baseline malignancy contributed to 50% of overall mortalities. Further details are provided in Table 1. Conclusion Our study underscores the significant impact of CARV on hematological malignancy patients, especially with SARS-CoV-2 predominance. The distribution of CARVs reflected malignancy prevalence, with acute leukemias and non-Hodgkin lymphoma most affected. Moreover, we found heightened severity and mortality rates associated with specific CARV pathogens such as metapneumovirus and parainfluenza. Disclosures Oliver A. Cornely, Prof. Dr., Abbott: Honoraria|Abbvie: Advisor/Consultant|Abbvie: Honoraria|AiCuris: Advisor/Consultant|Akademie fur Infektionmedizin: Honoraria|Al-Jazeera Pharmaceuticals/Hikma: Honoraria|amedes: Honoraria|AstraZeneca: Honoraria|Basilea: Advisor/Consultant|Biocon: Advisor/Consultant|BMBF: Grant/Research Support|Boston Strategic Partners: Advisor/Consultant|CIdara: Advisor/Consultant|CIdara: Expert Testimony|CIdara: Grant/Research Support|CIdara: Participation on a DRC or DSMB|CoRe Consulting: Stocks/Bonds (Private Company)|Deutscher Arzteverlag: Honoraria|DZIF: Grant/Research Support|EasyRadiology: Stocks/Bonds (Private Company)|EU-DG RTD: Grant/Research Support|F2G: Grant/Research Support|Gilead: Advisor/Consultant|Gilead: Grant/Research Support|Gilead: Honoraria|Grupo Biotoscana/United Medical/Knight: Honoraria|GSK: Advisor/Consultant|GSK: Honoraria|IQVIA: Advisor/Consultant|IQVIA: Participation on a DRC or DSMB|Janssen: Advisor/Consultant|Janssen: Participation on a DRC or DSMB|Matinas: Advisor/Consultant|MedPace: Advisor/Consultant|MedPace: Grant/Research Support|MedPace: Participation on a DRC or DSMB|Medscape/WebMD: Honoraria|MedUpdate: Honoraria|Menarini: Advisor/Consultant|Moderna: Honoraria|Molecular Partners: Advisor/Consultant|MSD: Grant/Research Support|MSD: Honoraria|MSG-ERC: Advisor/Consultant|Mundipharma: Advisor/Consultant|Mundipharma: Grant/Research Support|Mundipharma: Honoraria|Noscendo: Honoraria|Noxxon: Advisor/Consultant|Octapharma: Advisor/Consultant|Octapharma: Grant/Research Support|Pardes: Advisor/Consultant|Partner Therapeutics: Advisor/Consultant|Patent: US18/562644|Paul-Martini-Stiftung: Honoraria|Pfizer: Advisor/Consultant|Pfizer: Grant/Research Support|Pfizer: Honoraria|PSI: Advisor/Consultant|PSI: Participation on a DRC or DSMB|Pulmocide: Participation on a DRC or DSMB|Sandoz: Honoraria|Scynexis: Advisor/Consultant|Scynexis: Grant/Research Support|Seqirus: Advisor/Consultant|Seqirus: Honoraria|Seres: Advisor/Consultant|Shionogi: Advisor/Consultant|Shionogi: Honoraria|streamedup!: Honoraria|The Prime Meridian Group: Advisor/Consultant|Touch Independent: Honoraria|Vitis: Honoraria

P-1013. Incidence and Risk Factors for Fungal Infection after CD19-targeted Chimeric Antigen Receptor T cell Therapy for Non-Hodgkin Lymphoma

Abstract Background Chimeric antigen receptor T cell therapy (CAR T) is highly effective for the treatment of non-Hodgkin lymphoma (NHL); however, recipients are at risk of infectious complications. Infections following CAR T are predominantly bacterial or viral; nevertheless, a subset of recipients develop invasive fungal disease (IFD). The limited evidence guiding antifungal prophylaxis (PPx) led us to investigate the incidence and risk factors for IFD at our center. Legend: DLBCL=diffuse large B-cell lymphoma; MCL=mantle cell lymphoma; tFL=transformed follicular lymphoma; PMBCL=primary mediastinal large B-cell lymphoma; HGBCL= high-grade B-cell lymphoma; autoHCT=autologous hematopoietic cell transplant; alloHCT=allogeneic hematopoietic cell transplant; CAR =chimeric antigen receptor; Axi-cel=axicabtagene ciloleucel; Brexu-cel=brexucabtagene autoleucel; Tisa-cel=tisagenlecleucel; CRS=cytokine release syndrome; ICANS= immune effector cell-associated neurotoxicity syndrome; IEC-HS/MAS= immune effector cell-associated HLH-like syndrome/macrophage activation syndrome; IgG=immunoglobulin G; G-CSF=granulocyte colony-stimulating factor Methods Adults with NHL who received commercial CAR T between January 2018 and February 2021 at MD Anderson Cancer Center were retrospectively identified. Demographics, oncologic history, and complications related to therapy were collected. Consensus definitions were used to define probable and proven IFD. Patients were observed for 1 year after CAR T or until death, whichever occurred first. Routine antifungal PPx was administered per institutional protocol. This database was built with funds from Merck. Legend: IFD=invasive fungal disease; PJP=Pneumocystis jirovecii pneumonia Results A total of 219 patients were identified (Table 1). Most patients had an underlying diagnosis of diffuse large B cell lymphoma (73.5%) and received axicabtagene ciloleucel (93.6%). Therapy related toxicities included: cytokine release syndrome (CRS) (88.1%), immune effector cell-associated neurotoxicity syndrome (ICANS) (58.9%) and immune effector cell-associated hemophagocytic lymphohistiocytosis-like syndrome (IEC-HS) (8.2%). Sixteen patients (7.3%) developed IFD, including 9 (4.1%) mold infections (Table 2). In univariate analysis (Table 3a), IEC-HS, grade 4 CRS, grade 4 ICANS, and any infection within 30 days prior to CAR T were associated with IFD. In multivariate analysis (Table 3b), grade 4 CRS, grade 4 ICANS, and any infection within 30 days prior to CAR T were independent predictors for IFD. Factors associated with mold infections in univariate analysis (Table 3c) included IEC-HS, grade 4 CRS, grade 4 ICANS, steroid use, prior hematopoietic cell transplantation (HCT), and any infection documented within 30 days prior to CAR T. Legend: IFD=invasive fungal disease; cHR= Crude hazard ratio; 95% CI= 95% Confidence interval; aHR= Adjusted hazard ratio; CAR T=Chimeric antigen receptor T cell therapy; HCT=autologous hematopoietic cell transplant; CRS=cytokine release syndrome; ICANS= immune effector cell-associated neurotoxicity syndrome; IEC-HS/MAS= immune effector cell-associated HLH-like syndrome/macrophage activation syndrome; ANC=absolute neutrophil count; ALC=absolute lymphocyte count. Note:* indicates the variable was treated as a time-dependent variable in the analysis. Multivariate analysis on mold infection was not performed due to the small number of the events. Conclusion IFD after CAR T for NHL is uncommon. Higher grade toxicities and their treatment, as well as prior HCT and prior infections, may identify those at highest risk. Additional studies are needed to individualize antifungal PPx strategies in this population. Disclosures Charles Gaulin, MBBS, ADC Therapeutics: Honoraria|DeciBio: Advisor/Consultant|Sanofi: Honoraria Roy F. Chemaly, MD/MPH, AiCuris: Advisor/Consultant|AiCuris: Grant/Research Support|Ansun Pharmaceuticals: Advisor/Consultant|Ansun Pharmaceuticals: Grant/Research Support|Astellas: Advisor/Consultant|Eurofins-Viracor: Grant/Research Support|InflaRX: Advisor/Consultant|Janssen: Advisor/Consultant|Karius: Advisor/Consultant|Karius: Grant/Research Support|Merck/MSD: Advisor/Consultant|Merck/MSD: Grant/Research Support|Moderna: Advisor/Consultant|Oxford Immunotec: Advisor/Consultant|Oxford Immunotec: Grant/Research Support|Roche/Genentech: Advisor/Consultant|Roche/Genentech: Grant/Research Support|Shinogi: Advisor/Consultant|Takeda: Advisor/Consultant|Takeda: Grant/Research Support|Tether: Advisor/Consultant Fareed Khawaja, MBBS, Eurofins Viracor: Grant/Research Support|Symbio: Grant/Research Support