{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,10]],"date-time":"2026-01-10T20:13:37Z","timestamp":1768076017082,"version":"3.49.0"},"reference-count":27,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2023,8,10]],"date-time":"2023-08-10T00:00:00Z","timestamp":1691625600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Cancer Reports"],"published-print":{"date-parts":[[2023,10]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>CD19\u2010targeted chimeric antigen receptor (CAR)\u2010T cell therapy involves administration of patient\u2010derived T cells that target B cells, resulting in B\u2010cell depletion and aplasia. In immunity against <jats:italic>Pneumocystis jirovecii<\/jats:italic> (<jats:italic>Pj<\/jats:italic>), CD4+ T cells and, more recently, B cells, are generally considered important. Antigen presentation by B cells to CD4+ T cells is particularly important. Trimethoprim\u2010sulfamethoxazole (TMP\/SMX) for <jats:italic>Pj<\/jats:italic> pneumonia (PJP) prophylaxis is generally discontinued when the CD4+ T\u2010cell count is &gt;200\/\u03bcL. Here we report the first case, to our knowledge, of PJP in a patient with a CD4+ T cell count of &gt;200\/\u03bcL after CAR\u2010T cell therapy.<\/jats:p><\/jats:sec><jats:sec><jats:title>Case<\/jats:title><jats:p>A 14\u2010year\u2010old girl developed hemophagocytic lymphohistiocytosis (HLH) after cord blood transplantation (CBT) for relapsed precursor B\u2010cell acute lymphoblastic leukemia (B\u2010ALL). Twenty\u2010one months after CBT, she was diagnosed with combined second relapse in the bone marrow and central nervous system. The patient was treated with CD19\u2010targeted CAR\u2010T cell therapy for the relapse. After CAR\u2010T cell therapy, the patient remained in remission and continued to receive TMP\/SMX for PJP prophylaxis. Seven months after CAR\u2010T cell therapy, CD4+ T cells recovered and TMP\/SMX was discontinued. The B\u2010cell aplasia persisted. Ten months after CAR\u2010T cell therapy, the patient developed PJP. The patient was also considered to have macrophage hyperactivation at the onset of PJP. Treatment with immunoglobulin, TMP\/SMX, and prednisolone was initiated, and the patient's symptoms rapidly ameliorated.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>The patient in the present case developed PJP despite a CD4+ T\u2010cell count of &gt;200\/\u03bcL after CAR\u2010T cell therapy, probably because of inadequate CD4+ T\u2010cell activation caused by B\u2010cell depletion after CAR\u2010T cell therapy and repeated abnormal macrophage immune responses after CBT. It is important to determine the duration of TMP\/SMX for prophylaxis after CAR\u2010T cell therapy according to each case, as well as the CD4+ T\u2010cell count.<\/jats:p><\/jats:sec>","DOI":"10.1002\/cnr2.1885","type":"journal-article","created":{"date-parts":[[2023,8,11]],"date-time":"2023-08-11T03:42:25Z","timestamp":1691725345000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["<i>Pneumocystis jirovecii<\/i> pneumonia after <scp>CD4<\/scp>+ T\u2010cell recovery subsequent to <scp>CD19<\/scp>\u2010targeted chimeric antigen receptor T\u2010cell therapy: A case report and brief review of literature"],"prefix":"10.1002","volume":"6","author":[{"ORCID":"https:\/\/orcid.org\/0009-0000-4354-6976","authenticated-orcid":false,"given":"Kento","family":"Kawata","sequence":"first","affiliation":[{"name":"Department of Pediatrics Keio University School of Medicine  Tokyo 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