Infectious complications after CAR T-cell therapy: mechanisms, risk stratification, and prevention

Area of Science:

• Oncology
• Immunology
• Infectious Diseases

Background:

• Chimeric antigen receptor (CAR) T-cell therapy is effective for B-cell malignancies.
• Infections are a significant cause of morbidity and mortality post-CAR T-cell therapy.
• Immunosuppression is multifactorial, including chemotherapy, cytopenia, T-cell lymphopenia, B-cell aplasia, and managing toxicities.

Purpose of the Study:

• To review the mechanisms of infection following CAR T-cell therapy.
• To outline risk stratification and preventive strategies for infections.
• To summarize current evidence and international guideline recommendations.

Main Methods:

• Review of current evidence and international guidelines.
• Analysis of infection mechanisms and risk factors.
• Summary of preventive strategies including prophylaxis and immune support.

Main Results:

• Infection spectrum evolves: bacterial early, viral/opportunistic later.
• BCMA-directed CAR T-cell therapy linked to higher infection burden.
• Preventive strategies include prophylaxis, immunoglobulin replacement, and vaccination.

Conclusions:

• Coordinated, risk-adapted infection prevention is essential.
• Minimizing infectious complications improves long-term outcomes.
• Structured prevention strategies are key for patients undergoing CAR T-cell therapy.