CAR-T cell therapy and infection: a review

ABSTRACT

Introduction: Chimeric antigen receptor T-cell therapy (CAR-T cell therapy) is a novel immunotherapy with promising results in the treatment of relapsed or refractory B cell malignancies. Patients undergoing CAR-T cell therapy are at increased risk of infection due to prior immunosuppression, lymphodepleting chemotherapy, treatment of unique toxicities with tocilizumab and/or steroids, on-target effects of hypogammaglobulinaemia, and prolonged cytopenias.

Areas covered: A narrative review of infections (PubMed, August 2020) occurring in patients undergoing CAR-T cell therapy is described, and the evidence for infection prevention strategies is presented.

Expert commentary: The rapid adoption of CAR-T cell therapy into clinical practice presents many challenges for the diagnosis, management, and prevention of infection. Ongoing surveillance of the spectrum of infectious complications and effectiveness of prophylaxis is required to support safe and effective patient care.

KEYWORDS:

• CAR-T cell therapy
• infection
• antimicrobial prophylaxis
• hematological malignancy
• infection prevention

Article highlights

• Patients undergoing CAR-T cell therapy are at increased risk of infection due to prior immunosuppression, lymphodepleting chemotherapy, treatment of unique toxicities with tocilizumab and steroids, B cell aplasia, hypogammaglobulinaemia and prolonged cytopenias.

• Infections are common, particularly early post CAR-T cell therapy, but the majority of infections are of mild to moderate severity.

• There is a lack of clinical studies defining effective infection prevention strategies in patients undergoing CAR-T cell therapy.

• Current recommendations are extrapolated from other hematological treatment modalities.

Declaration of interest

G Haeusler discloses a grant from Gilead (not related to this work) M Slavin discloses grants from Gilead, Merck Sharp & Dohme, F25 (not related to this work), and acknowledges CRE NCIC NHMRC Grant 1116876 (not related to this work). B Teh is on the advisory board of CSL Behring, discloses grant funding from Merck Sharp & Dohme (not related to this work). The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.