Infectious Complications Following CD30 Chimeric Antigen Receptor T-cell Therapy in Adults

Infections are increasingly recognized as a complication of chimeric antigen receptor T-cell (CAR-T) therapy however the incidence of infections after non-CD19 targeted CAR-T is not yet known. We report, for the first time, infectious complications after CD30 CAR T-cell treatment for patients with Hodgkin lymphoma and peripheral T-cell lymphoma. We retrospectively evaluated all 64 adult patients with relapsed/refractory CD30+ lymphomas who received anti-CD30 CAR T-cells at a single institution between 2016-2021. We assessed microbiologically confirmed infections within 1 year after cell infusion, censoring for relapse. We calculated infection density (total infections per 100 patient-days-at-risk), and cumulative incidence of infection divided into time periods postinfusion (days 0-28, 29-90, and 91-365). We compared infectious outcomes to a concurrent cohort of CD19 CAR-T recipients (n = 50) at the same institution. Infection density in the first year after CD30 CAR T-cell infusion was 0.131 per 100 patient-days-at-risk, with 17 patients developing 19 total infections including 15 mild, 3 moderate, and 1 severe infection (1-year cumulative incidence of 32%; 95% confidence interval [CI], 19-47]). Infections were primarily viral (30%; 95% CI, 17-44) and most common early after infusion. Far fewer infections were bacterial in CD30 CAR-T recipients (4.9%; 95% CI, 1.3-13), in contrast to the CD19 cohort in which bacterial infections predominated and were more severe. Microbiologically confirmed infections, primarily with respiratory viruses, were most common in the first 28 days after CD30 CAR-T infusion and most were mild. Our findings may have implications for antimicrobial prophylaxis guidelines after CD30 CAR-T therapy.