Cytomegalovirus Infection After Chimeric Antigen Receptor T-Cell Therapy or Bispecific Antibody Treatment for...

Limited data exists on the incidence of CMV infections after chimeric antigen receptor (CAR) T-cell or bispecific antibody (BsAb) therapy for hematologic malignancies.

We reviewed medical records of patients with hematologic malignancies treated with CAR T-cells or BsAbs between July 2018 and October 2024 in a tertiary hospital in Seoul, South Korea. CMV infections were detected using CMV DNA qPCR assays performed within 180 days after CAR T-cell infusion or the last BsAb treatment. Secondary outcomes were the occurrence of clinically significant CMV infections (CS-CMVi) and end-organ diseases.

Of 179 patients, 76 (42%) received CAR T-cell therapy, and 103 (58%) received BsAb therapy. The incidence of CMV infection was 62% in BsAb recipients, and 43% in CAR T-cell recipients. Two (6.1% of total CMV infections) CAR T-cell recipients had CS-CMVi, and 1 (3.0%) developed possible CMV pneumonia. In the BsAb group, 10 (16% of total CMV infections) patients received antiviral therapy, and 4 (6.3%) had end-organ diseases. Receiving three or more previous systemic chemotherapy regimens in the CAR T-cell group was associated with increased CMV infection risks (HR 4.7, 95% CI 1.88-11.8, p < 0.001), and older age in the BsAb group had a trend toward having more CMV infection (HR 1.02, 95% CI 1.00-1.05, p = 0.06).

Approximately 43% and 62% of patients receiving CAR T-cell and BsAb therapy had CMV infection, with 1%-4% developing CMV diseases. Effective strategies for preventing CMV infections in these patients are warranted.