Cytomegalovirus (CMV) Reactivation within in the First Year after Chimeric Antigen Receptor (CAR) T Cell Therapy: Experience from the First Two Years at a Major Cancer Center

Khawaja, Fareed; Prakash, Rishab; Sassine, Joseph; Handley, Guy; VanWieren, Tracy; Angelidakis, Georgios; Iyer, Swaminathan Padmanabhan; Ramdial, Jeremy; Ahmed, Sairah; Nieto, Yago; Spallone, Amy; Ariza-Heredia, Ella J.; Chemaly, R.

doi:10.1182/blood-2022-167908

Cited by 6 publications

(3 citation statements)

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“…Higher grade neutropenia, CRS scores of 2 or higher, and higher cumulative systemic glucocorticoid dosing were all associated with a higher incidence of CMV infection. Notably, 33% of patients reviewed in their analysis had end‐organ disease, and a higher overall mortality relative to CMV non‐infected patients 25 . In a single‐center retrospective analysis by Márquez‐Algaba et al., 22% of patients developed quantitative CMV viral loads of greater than or equal to 1000 IU/mL.…”

Section: Discussionmentioning

confidence: 98%

“…Notably, 33% of patients reviewed in their analysis had end-organ disease, and a higher overall mortality relative to CMV non-infected patients. 25 In a single-center retrospective analysis by Márquez-Algaba et al, 22% of patients developed quantitative CMV viral loads of greater than or equal to 1000 IU/mL. Four patients received treatment for CMV infection and no patients with end-organ disease were identified.…”

Section: Viral Infections and Antiviral Prophylaxismentioning

confidence: 99%

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Infectious complications among CD19 CAR‐T cell therapy recipients: A single‐center experience

Walker,

Zimmer,

Stohs

et al. 2023

Transplant Infectious Dis

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BackgroundCD19 chimeric antigen receptor (CAR)‐T cell therapy has emerged as an effective treatment in those with refractory or relapsed lymphoma. CD19 CAR‐T cell therapy can cause direct and indirect toxic adverse effects and increased risk for infection. Infectious complications and optimal antimicrobial prophylaxis strategies are an ongoing area of investigation.MethodsA single‐center retrospective cohort study was conducted to review recipients of CD19 CAR‐T cell therapy between April 2018 and December 2020. Patient characteristics and clinical outcomes were extracted from the electronic health records.ResultsInfectious complications were identified in 18/50 (36%) recipients with 31 episodes of infection. The median time to infection was 225 days (range 0–614). Bacterial infections were most common with bloodstream infection followed by sinusitis and skin and soft tissue infection. Eight viral infections were identified, most being respiratory viral illnesses. Two fungal infections were identified: Pneumocystis jirovecii pneumonia (PJP) and disseminated fusariosis. Seventeen infections (54.8%) were classified as severe: leading to death, requiring hospitalization, need for empiric intravenous antibiotics, or significant alteration in hospital course. No characteristics were found to be statistically significant risks for infection, although a trend toward significance was seen in prior autologous stem cell transplant recipients (p = .12) and those with recurrent neutropenia (p = .14). Three patients (6%) died from infection.ConclusionInfections were common after CD19 CAR‐T cell therapy and occurred beyond the first year. Further multicenter studies are needed to define infectious risks and optimize antimicrobial prophylaxis recommendations in recipients of CD19 CAR‐T cell therapy. image

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Section: Discussionmentioning

confidence: 98%

Section: Viral Infections and Antiviral Prophylaxismentioning

confidence: 99%

Infectious complications among CD19 CAR‐T cell therapy recipients: A single‐center experience

Walker,

Zimmer,

Stohs

et al. 2023

Transplant Infectious Dis

View full text Add to dashboard Cite

show abstract

“…reported among 230 CD-19 CAR-T recipients, 10% developed clinically significant CMV infection. CMV infection was observed more among the female gender, with low ANC and monocyte count at day 30, grade 2 or higher CRS or ICANS requiring higher doses of steroids with higher mortality ( 66 ). These results demonstrate that CMV can cause disease in specific high-risk groups after CAR T-cell therapy.…”

Section: Factors Associated With Infectious Riskmentioning

confidence: 99%

Overview of infectious complications among CAR T- cell therapy recipients

Arya,

Shahid

2024

Front. Oncol.

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Chimeric antigen receptor-modified T cell (CAR T-cell) therapy has revolutionized the management of hematological malignancies. In addition to impressive malignancy-related outcomes, CAR T-cell therapy has significant toxicity-related adverse events, including cytokine release syndrome (CRS), immune effector cell associated neurotoxicity syndrome (ICANS), immune effector cell-associated hematotoxicity (ICAHT), and opportunistic infections. Different CAR T-cell targets have different epidemiology and risk factors for infection, and these targets result in different long-term immunodeficiency states due to their distinct on-target and off- tumor effects. These effects are exacerbated by the use of multimodal immunosuppression in the management of CRS and ICANS. The most effective course of action for managing infectious complications involves determining screening, prophylactic, and monitoring strategies and understanding the role of immunoglobulin replacement and re-vaccination strategies. This involves considering the nature of prior immunomodulating therapies, underlying malignancy, the CAR T-cell target, and the development and management of related adverse events. In conclusion, we now have an increasing understanding of infection management for CAR T-cell recipients. As additional effector cells and CAR T-cell targets become available, infection management strategies will continue to evolve.

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Best Practice Considerations by The American Society of Transplant and Cellular Therapy: Infection Prevention and Management After Chimeric Antigen Receptor T Cell Therapy for Hematological Malignancies

Shahid,

Jain,

Dioverti

et al. 2024

Transplantation and Cellular Therapy

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Cytomegalovirus (CMV) Reactivation within in the First Year after Chimeric Antigen Receptor (CAR) T Cell Therapy: Experience from the First Two Years at a Major Cancer Center

Cited by 6 publications

References 0 publications

Infectious complications among CD19 CAR‐T cell therapy recipients: A single‐center experience

Infectious complications among CD19 CAR‐T cell therapy recipients: A single‐center experience

Overview of infectious complications among CAR T- cell therapy recipients

Best Practice Considerations by The American Society of Transplant and Cellular Therapy: Infection Prevention and Management After Chimeric Antigen Receptor T Cell Therapy for Hematological Malignancies

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