[Infectious complications following chimeric antigen receptor T-cell therapy for a hematologic malignancy within 28
1Institute of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology; Hubei Clinical Medical Center of Cell Therapy for Neoplastic Disease, Wuhan 430022, China.
Infections are common after CAR-T cell therapy for blood cancers, with bacterial infections frequent. Acute lymphoblastic leukemia patients, prior infection history, and severe cytokine release syndrome (CRS) increase infection risk.
Area of Science:
- Hematology
- Oncology
- Infectious Diseases
Background:
- Chimeric antigen receptor (CAR) T-cell therapy is a promising treatment for hematologic malignancies.
- Infections are a significant complication following CAR-T cell infusion, impacting patient outcomes.
- Understanding infection patterns and risk factors is crucial for managing patients undergoing CAR-T cell therapy.
Purpose of the Study:
- To determine the incidence, clinical, and microbiological characteristics of infections within 28 days post-CAR-T cell infusion.
- To identify risk factors associated with infection in patients with acute lymphoblastic leukemia (ALL), non-Hodgkin lymphoma (NHL), and multiple myeloma (MM).
- To provide data supporting early infection detection and rational antibiotic use in this patient population.
Main Methods:
- Retrospective analysis of 170 patients (72 ALL, 56 NHL, 42 MM) treated with CAR-T cells from January 2016 to December 2020.
- Collected data on clinical characteristics of infections occurring within 28 days post-infusion.
- Employed Poisson and Cox proportional hazard regression models to assess pre- and post-infusion infection risk factors.
Main Results:
- A cumulative infection rate of 58.2% was observed in 99 out of 170 patients within 28 days.
- Bacterial infections accounted for 98 cases in 78 patients, with a cumulative incidence of 45.9%.
- High-risk factors for infection included ALL, prior infection history, refractory disease, low absolute neutrophil count (ANC <0.5×10^9/L), and grade 3/4 cytokine release syndrome (CRS).
Conclusions:
- Infection is a frequent complication of CAR-T cell therapy in hematologic malignancies, with bacterial infections being predominant.
- Specific patient factors like ALL, prior infections, refractory disease, low ANC, and severe CRS are significant risk factors.
- These findings aid in early identification and management of infections in CAR-T cell-treated patients.
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