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Donadel CD, De Santis GC, Gonçalves TE, Pires BG, Palma LC, Gava F, Guerino-Cunha RL, Faria JTB, Silva GVA, Darrigo-Junior LG, Fatobene G, Rocha V, Covas DT, Calado RT, Clé DV. Safety and efficacy of a new academic CD19-directed CAR-T cell for refractory/relapsed non-Hodgkin lymphoma and acute lymphoblastic leukemia in Brazil. Bone Marrow Transplant 2024:10.1038/s41409-024-02283-6. [PMID: 38615142 DOI: 10.1038/s41409-024-02283-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Revised: 04/03/2024] [Accepted: 04/05/2024] [Indexed: 04/15/2024]
Affiliation(s)
- Camila D Donadel
- Department of Medical Imaging, Hematology and Oncology, Ribeirão Preto Medical School, University of São Paulo (USP), Ribeirão Preto, Brazil.
| | - Gil C De Santis
- Department of Medical Imaging, Hematology and Oncology, Ribeirão Preto Medical School, University of São Paulo (USP), Ribeirão Preto, Brazil
| | - Thiago E Gonçalves
- Department of Medical Imaging, Hematology and Oncology, Ribeirão Preto Medical School, University of São Paulo (USP), Ribeirão Preto, Brazil
| | - Bruno G Pires
- Department of Medical Imaging, Hematology and Oncology, Ribeirão Preto Medical School, University of São Paulo (USP), Ribeirão Preto, Brazil
| | - Leonardo C Palma
- Department of Medical Imaging, Hematology and Oncology, Ribeirão Preto Medical School, University of São Paulo (USP), Ribeirão Preto, Brazil
| | - Flavia Gava
- Department of Pediatrics, Ribeirão Preto Medical School, University of São Paulo (USP), Ribeirão Preto, Brazil
| | - Renato Luiz Guerino-Cunha
- Department of Medical Imaging, Hematology and Oncology, Ribeirão Preto Medical School, University of São Paulo (USP), Ribeirão Preto, Brazil
| | - Joana T B Faria
- Department of Pediatrics, Ribeirão Preto Medical School, University of São Paulo (USP), Ribeirão Preto, Brazil
| | - Gabriela V A Silva
- Department of Pediatrics, Ribeirão Preto Medical School, University of São Paulo (USP), Ribeirão Preto, Brazil
| | | | - Giancarlo Fatobene
- Department of Hematology, Hemotherapy & Cell Therapy and Laboratory of Medical Investigation in Pathogenesis and Directed Therapy in Onco-Immuno-Hematology. Hospital das Clínicas da Faculdade de Medicina, University of São Paulo (USP), São Paulo, Brazil
| | - Vanderson Rocha
- Department of Hematology, Hemotherapy & Cell Therapy and Laboratory of Medical Investigation in Pathogenesis and Directed Therapy in Onco-Immuno-Hematology. Hospital das Clínicas da Faculdade de Medicina, University of São Paulo (USP), São Paulo, Brazil
| | - Dimas T Covas
- Department of Medical Imaging, Hematology and Oncology, Ribeirão Preto Medical School, University of São Paulo (USP), Ribeirão Preto, Brazil
| | - Rodrigo T Calado
- Department of Medical Imaging, Hematology and Oncology, Ribeirão Preto Medical School, University of São Paulo (USP), Ribeirão Preto, Brazil
| | - Diego V Clé
- Department of Medical Imaging, Hematology and Oncology, Ribeirão Preto Medical School, University of São Paulo (USP), Ribeirão Preto, Brazil
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Kampouri E, Ibrahimi SS, Xie H, Wong ER, Hecht JB, Sekhon MK, Vo A, Stevens-Ayers TL, Green DJ, Gauthier J, Maloney DG, Perez A, Jerome KR, Leisenring WM, Boeckh MJ, Hill JA. Cytomegalovirus (CMV) Reactivation and CMV-Specific Cell-Mediated Immunity After Chimeric Antigen Receptor T-Cell Therapy. Clin Infect Dis 2024; 78:1022-1032. [PMID: 37975819 PMCID: PMC11006113 DOI: 10.1093/cid/ciad708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 11/03/2023] [Accepted: 11/16/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND The epidemiology of cytomegalovirus (CMV) after chimeric antigen receptor-modified T-cell immunotherapy (CARTx) is poorly understood owing to a lack of routine surveillance. METHODS We prospectively enrolled 72 adult CMV-seropositive CD19-, CD20-, or BCMA-targeted CARTx recipients and tested plasma samples for CMV before and weekly up to 12 weeks after CARTx. We assessed CMV-specific cell-mediated immunity (CMV-CMI) before and 2 and 4 weeks after CARTx, using an interferon γ release assay to quantify T-cell responses to IE-1 and pp65. We tested pre-CARTx samples to calculate a risk score for cytopenias and infection (CAR-HEMATOTOX). We used Cox regression to evaluate CMV risk factors and evaluated the predictive performance of CMV-CMI for CMV reactivation in receiver operator characteristic curves. RESULTS CMV was detected in 1 patient (1.4%) before and in 18 (25%) after CARTx, for a cumulative incidence of 27% (95% confidence interval, 16.8-38.2). The median CMV viral load (interquartile range) was 127 (interquartile range, 61-276) IU/mL, with no end-organ disease observed; 5 patients received preemptive therapy based on clinical results. CMV-CMI values reached a nadir 2 weeks after infusion and recovered to baseline levels by week 4. In adjusted models, BCMA-CARTx (vs CD19/CD20) and corticosteroid use for >3 days were significantly associated with CMV reactivation, and possible associations were detected for lower week 2 CMV-CMI and more prior antitumor regimens. The cumulative incidence of CMV reactivation almost doubled when stratified by BCMA-CARTx target and use of corticosteroids for >3 days (46% and 49%, respectively). CONCLUSIONS CMV testing could be considered between 2 and 6 weeks in high-risk CARTx recipients.
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Affiliation(s)
- Eleftheria Kampouri
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, Seattle, Washington, USA
| | - Sarah S Ibrahimi
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, Seattle, Washington, USA
| | - Hu Xie
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, Washington, USA
| | - Elizabeth R Wong
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, Seattle, Washington, USA
| | - Jessica B Hecht
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, Seattle, Washington, USA
| | - Mandeep K Sekhon
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, Seattle, Washington, USA
| | - Alythia Vo
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, Seattle, Washington, USA
| | - Terry L Stevens-Ayers
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, Seattle, Washington, USA
| | - Damian J Green
- Translational Science and Therapeutics Division, Fred Hutchinson Cancer Center, Seattle, Washington, USA
- Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Jordan Gauthier
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, Washington, USA
- Department of Medicine, University of Washington, Seattle, Washington, USA
| | - David G Maloney
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, Washington, USA
- Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Ailyn Perez
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, Washington, USA
| | - Keith R Jerome
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, Seattle, Washington, USA
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, Washington, USA
| | - Wendy M Leisenring
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, Washington, USA
- Public Health Sciences Division, Fred Hutchinson Cancer Center, Seattle, Washington, USA
| | - Michael J Boeckh
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, Seattle, Washington, USA
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, Washington, USA
- Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Joshua A Hill
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, Seattle, Washington, USA
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, Washington, USA
- Department of Medicine, University of Washington, Seattle, Washington, USA
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3
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O'Reilly MA, Neill L, Collin SM, Stone N, Springell D, Mensah J, Cheok KPL, Jalowiec K, Benjamin R, Kuhnl A, Roddie C, Sanderson R. High pretreatment disease burden as a risk factor for infectious complications following CD19 chimeric antigen receptor T-cell therapy for large B-cell lymphoma. Hemasphere 2024; 8:e29. [PMID: 38434533 PMCID: PMC10878197 DOI: 10.1002/hem3.29] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 11/22/2023] [Indexed: 03/05/2024] Open
Abstract
Infection has emerged as the chief cause of non-relapse mortality (NRM) post CD19-targeting chimeric antigen receptor T-cell therapy (CAR-T) therapy. Even though up to 50% of patients may remain infection-free, many suffer multiple severe, life-threatening, or fatal infectious events. The primary aim of this study was to explore severe and life-threatening infections post licensed CAR-T therapy in large B-cell lymphoma, with a focus on the role of disease burden and disease sites in assessing individual risk. We sought to understand the cohort of patients who experience ≥2 infections and those at the highest risk of infectious NRM. Our analysis identifies a higher disease burden after bridging therapy as associated with infection events. Those developing ≥2 infections emerged as a uniquely high-risk cohort, particularly if the second (or beyond) infection occurred during an episode of immune effector cell-associated neurotoxicity syndrome (ICANS) or while on steroids and/or anakinra for ICANS. Herein, we also describe the first reported cases of "CAR-T cold sepsis," a phenomenon characterized by the lack of an appreciable systemic inflammatory response at the time of detection of infection. We propose a risk-based strategy to encourage heightened clinician awareness of cold sepsis, with a view to reducing NRM.
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Affiliation(s)
- Maeve A. O'Reilly
- Department of HaematologyUniversity College London HospitalLondonUK
- University College London Cancer InstituteLondonUK
| | - Lorna Neill
- Department of HaematologyUniversity College London HospitalLondonUK
| | | | - Neil Stone
- Department of Infectious DiseasesUniversity College London HospitalLondonUK
| | | | - Jeremy Mensah
- Department of HaematologyKing's College London HospitalLondonUK
| | | | | | - Reuben Benjamin
- Department of HaematologyKing's College London HospitalLondonUK
| | - Andrea Kuhnl
- Department of HaematologyKing's College London HospitalLondonUK
| | - Claire Roddie
- Department of HaematologyUniversity College London HospitalLondonUK
- University College London Cancer InstituteLondonUK
| | - Robin Sanderson
- Department of HaematologyKing's College London HospitalLondonUK
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Kampouri E, Little JS, Rejeski K, Manuel O, Hammond SP, Hill JA. Infections after chimeric antigen receptor (CAR)-T-cell therapy for hematologic malignancies. Transpl Infect Dis 2023; 25 Suppl 1:e14157. [PMID: 37787373 DOI: 10.1111/tid.14157] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 08/30/2023] [Accepted: 09/10/2023] [Indexed: 10/04/2023]
Abstract
BACKGROUND Chimeric antigen receptor (CAR)-T-cell therapies have revolutionized the management of acute lymphoblastic leukemia, non-Hodgkin lymphoma, and multiple myeloma but come at the price of unique toxicities, including cytokine release syndrome, immune effector cell-associated neurotoxicity syndrome, and long-term "on-target off-tumor" effects. METHODS All of these factors increase infection risk in an already highly immunocompromised patient population. Indeed, infectious complications represent the key determinant of non-relapse mortality after CAR-T cells. The temporal distribution of these risk factors shapes different infection patterns early versus late post-CAR-T-cell infusion. Furthermore, due to the expression of their targets on B lineage cells at different stages of differentiation, CD19, and B-cell maturation antigen (BCMA) CAR-T cells induce distinct immune deficits that could require different prevention strategies. Infection incidence is the highest during the first month post-infusion and subsequently decreases thereafter. However, infections remain relatively common even a year after infusion. RESULTS Bacterial infections predominate early after CD19, while a more equal distribution between bacterial and viral causes is seen after BCMA CAR-T-cell therapy, and fungal infections are universally rare. Cytomegalovirus (CMV) and other herpesviruses are increasingly breported, but whether routine monitoring is warranted for all, or a subgroup of patients, remains to be determined. Clinical practices vary substantially between centers, and many areas of uncertainty remain, including CMV monitoring, antibacterial and antifungal prophylaxis and duration, use of immunoglobulin replacement therapy, and timing of vaccination. CONCLUSION Risk stratification tools are available and may help distinguish between infectious and non-infectious causes of fever post-infusion and predict severe infections. These tools need prospective validation, and their integration in clinical practice needs to be systematically studied.
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Affiliation(s)
- Eleftheria Kampouri
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, Seattle, Washington, USA
- Infectious Diseases Service, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Jessica S Little
- Division of Infectious Diseases, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Division of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA
| | - Kai Rejeski
- Department of Medicine III-Hematology/Oncology, LMU University Hospital, LMU Munich, Munich, Germany
- German Cancer Consortium (DKTK), Munich site, and German Cancer Research Center, Heidelberg, Germany
| | - Oriol Manuel
- Infectious Diseases Service, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Sarah P Hammond
- Division of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA
- Divisions of Hematology/Oncology and Infectious Diseases, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Joshua A Hill
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, Seattle, Washington, USA
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, Washington, USA
- Department of Medicine, University of Washington, Seattle, Washington, USA
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5
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Medina I, Carpio C, Ruiz-Camps I, Albasanz-Puig A, Lopez-Godino O, Esperalba J, Beas F, Sanchez-Salinas M, Iacoboni G, Barba P. Adenovirus-induced hemorrhagic cystitis after CD19-targeted chimeric antigen receptor T-cell therapy in a patient with large B-cell lymphoma. Immunotherapy 2023; 15:1369-1374. [PMID: 37718888 DOI: 10.2217/imt-2023-0111] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/19/2023] Open
Abstract
Chimeric antigen receptor (CAR) T cells targeting CD19 have changed the treatment landscape of patients with relapsed/refractory diffuse large B-cell lymphoma. Infections are one of the most frequent complications after CAR T-cell therapy. Most of these infections are bacterial, although viral infections can also occur in this setting. Adenovirus-induced hemorrhagic cystitis is a rare infectious complication and is usually observed after bone marrow or solid organ transplantation. Herein we report a case of adenovirus-induced hemorrhagic cystitis in a patient experiencing urinary symptoms within the first month after CAR T-cell infusion. Based on our experience and a literature review, we discuss the diagnostic approach and potential treatment options for this infrequent infection after CAR T-cell therapy.
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Affiliation(s)
- Irene Medina
- Department of Hematology, Experimental Hematology, Vall d'Hebron Institute of Oncology, University Hospital Vall d'Hebron, 08035, Barcelona, Spain
| | - Cecilia Carpio
- Department of Hematology, Experimental Hematology, Vall d'Hebron Institute of Oncology, University Hospital Vall d'Hebron, 08035, Barcelona, Spain
- Department of Medicine, Universitat Autònoma de Barcelona, 08193, Bellaterra, Spain
| | - Isabel Ruiz-Camps
- Department of Medicine, Universitat Autònoma de Barcelona, 08193, Bellaterra, Spain
- Department of Infectious Diseases, Vall d'Hebron Research Institute, University Hospital Vall d'Hebron, 08035, Barcelona, Spain
| | - Adaia Albasanz-Puig
- Department of Medicine, Universitat Autònoma de Barcelona, 08193, Bellaterra, Spain
- Department of Infectious Diseases, Vall d'Hebron Research Institute, University Hospital Vall d'Hebron, 08035, Barcelona, Spain
| | - Oriana Lopez-Godino
- Department of Hematology, Hospital Universitario Morales Meseguer, 30008, Murcia, Spain
| | - Juliana Esperalba
- Department of Microbiology, University Hospital Vall d'Hebron, 08035, Barcelona, Spain
| | - Francisco Beas
- Department of Hematology, Experimental Hematology, Vall d'Hebron Institute of Oncology, University Hospital Vall d'Hebron, 08035, Barcelona, Spain
| | - Mario Sanchez-Salinas
- Department of Hematology, Experimental Hematology, Vall d'Hebron Institute of Oncology, University Hospital Vall d'Hebron, 08035, Barcelona, Spain
- Department of Medicine, Universitat Autònoma de Barcelona, 08193, Bellaterra, Spain
| | - Gloria Iacoboni
- Department of Hematology, Experimental Hematology, Vall d'Hebron Institute of Oncology, University Hospital Vall d'Hebron, 08035, Barcelona, Spain
- Department of Medicine, Universitat Autònoma de Barcelona, 08193, Bellaterra, Spain
| | - Pere Barba
- Department of Hematology, Experimental Hematology, Vall d'Hebron Institute of Oncology, University Hospital Vall d'Hebron, 08035, Barcelona, Spain
- Department of Medicine, Universitat Autònoma de Barcelona, 08193, Bellaterra, Spain
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6
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Chen GL, Shpall EJ. Another tool against cytomegalovirus after allogeneic hematopoietic cell transplantation. J Clin Invest 2023; 133:e170282. [PMID: 37183817 PMCID: PMC10178833 DOI: 10.1172/jci170282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2023] Open
Abstract
Cytomegalovirus (CMV) viremia from reactivation of latent infection is a common complication after allogeneic hematopoietic cell transplantation (HCT). Untreated, CMV viremia can progress to affect other organs, resulting in organ dysfunction with high morbidity and mortality. In this issue of the JCI, Prockop and authors demonstrate that third-party donor T cells sensitized ex vivo to CMV pp65-derived overlapping pentadecapeptides are safe and effective for the treatment of CMV reactivation or CMV disease refractory to first-line pharmacotherapies occurring after HCT. They also provide insight into the biological differences between responders and nonresponders. This work confirms the utility of third-party CMV pp65 VSTs and suggests strategies for further improving the efficacy of this cell-therapy approach.
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Solano de la Asunción C, Hernani R, Albert E, Gómez MD, Giménez E, Benzaquén A, González-Barberá EM, Hernández-Boluda JC, Pérez A, Piñana JL, Chorao P, Guerreiro M, Montoro J, Sanz J, Solano C, Navarro D. Cytomegalovirus DNAemia in hematological patients undergoing CD19-directed CAR-T cell therapy: should it be systematically monitored? Clin Microbiol Infect 2023:S1198-743X(23)00234-3. [PMID: 37182642 DOI: 10.1016/j.cmi.2023.05.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 04/16/2023] [Accepted: 05/06/2023] [Indexed: 05/16/2023]
Affiliation(s)
| | - Rafael Hernani
- Hematology Service, Hospital Clínico Universitario, INCLIVA Health Research Institute, Valencia, Spain
| | - Eliseo Albert
- Microbiology Service,Hospital Clínico Universitario,INCLIVA Health Research Institute,Valencia,Spain
| | - María Dolores Gómez
- Microbiology Service,Hospital Universitario y Politécnico "La Fe",Valencia,Spain
| | - Estela Giménez
- Microbiology Service,Hospital Clínico Universitario,INCLIVA Health Research Institute,Valencia,Spain; Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Ana Benzaquén
- Hematology Service, Hospital Clínico Universitario, INCLIVA Health Research Institute, Valencia, Spain
| | | | - Juan Carlos Hernández-Boluda
- Hematology Service, Hospital Clínico Universitario, INCLIVA Health Research Institute, Valencia, Spain; Department of Medicine,School of Medicine,University of Valencia,Valencia,Spain
| | - Ariadna Pérez
- Hematology Service, Hospital Clínico Universitario, INCLIVA Health Research Institute, Valencia, Spain
| | - José Luis Piñana
- Hematology Service, Hospital Clínico Universitario, INCLIVA Health Research Institute, Valencia, Spain
| | - Pedro Chorao
- Hematology Service, Hospital Universitario y Politécnico "La Fe", Valencia, Spain
| | - Manuel Guerreiro
- Hematology Service, Hospital Universitario y Politécnico "La Fe", Valencia, Spain
| | - Juan Montoro
- Hematology Service, Hospital Universitario y Politécnico "La Fe", Valencia, Spain
| | - Jaime Sanz
- Hematology Service, Hospital Universitario y Politécnico "La Fe", Valencia, Spain
| | - Carlos Solano
- Hematology Service, Hospital Clínico Universitario, INCLIVA Health Research Institute, Valencia, Spain; Department of Medicine,School of Medicine,University of Valencia,Valencia,Spain
| | - David Navarro
- Microbiology Service,Hospital Clínico Universitario,INCLIVA Health Research Institute,Valencia,Spain; Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain; Department of Microbiology,School of Medicine,University of Valencia,Valencia,Spain.
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