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Infections following chimeric antigen receptor T cell therapy: 2018-2022.

Vishakh C Keri¹, Lea M Monday¹, Jahanavi M Ramakrishna²

¹Division of Infectious diseases, Wayne State University, Detroit, Michigan, USA.

Transplant Infectious Disease : an Official Journal of the Transplantation Society

|September 23, 2024

Summary

Infectious complications, including COVID-19 and C. difficile, are common after CAR T-cell therapy, often occurring within 100 days. Antimicrobial stewardship is crucial, especially for patients with CRS/ICANS.

Keywords:

CAR T‐cell therapy Clostridioides difficile infections

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Area of Science:

Oncology
Immunotherapy
Infectious Diseases

Background:

Chimeric antigen receptor (CAR) T-cell therapy is a promising treatment for hematological malignancies.
Infectious complications post-CAR T-cell therapy require further definition.

Purpose of the Study:

To define the spectrum and incidence of infectious complications following CAR T-cell therapy.
To identify common pathogens and risk factors for infection.

Main Methods:

Retrospective analysis of 76 patients receiving CAR T-cell therapy (April 2018 - December 2022).
Data collected on infectious episodes, pathogens, and clinical outcomes.
Time-to-event analysis performed for infection onset.

Main Results:

43.4% of patients experienced at least one infectious episode.
Bacterial and viral infections were most common; COVID-19 (14.8%) and Clostridioides difficile (11.5%) were leading complications.
Most infections occurred within 100 days; empirical antibiotics and C. difficile were frequent in patients with Cytokine Release Syndrome/Immune effector Cell-Associated Neurotoxicity Syndrome (CRS/ICANS).

Conclusions:

COVID-19 and C. difficile infections are significant concerns after CAR T-cell therapy.
Early identification and management of infections within 100 days are critical.
Antimicrobial stewardship is essential, particularly for CRS/ICANS patients.