Characteristics and recognition of early infections in patients treated with commercial anti-CD19 CAR-T cells.
Ofrat Beyar-KatzNino KikozashviliYael Bar OnOdelia AmitChava PerryIrit AviviRonit GoldYair HerishanuNoam BenyaminiAdrian DuekRonen Ben-AmiDavid ShashaRon RamPublished in: European journal of haematology (2021)
The characteristics of infections following chimeric antigen receptor T (CAR-T) cells targeting CD19 in real-word population are obscure. We analyzed infections' characteristics in the first month among consecutive patients with diffuse large B-cell lymphoma (DLBCL) (n = 60, median age, 69.3 years), treated with commercial CAR-T cells. ECOG performance status (PS) was 2-3 in most patients (58%). Infections were observed in 45% of patients (16, 27%, bacterial infections, and 14, 23%, viral infections). Bacterial infection included clinically documented infection in 7 (Pneumonia, n = 5; periodontal infection, n = 1; and cellulitis, n = 1) and microbiology documented infection (MDI) in 9 patients (Gram-negative rod, n = 5; Gram-positive cocci, n = 3, bacteremia; polymicrobial, n = 1). The most common viral infection was cytomegalovirus (CMV) reactivation (n = 10, 17%) leading to initiation of anti-CMV treatment in 6 (60%) among these patients. None had CMV disease. In univariate analysis, immune effector cell-associated neurotoxicity syndrome (ICANS) was associated with higher incidence of bacterial infection (OR=4.5, P = .018), while there was a trend for lower incidence of bacterial infections in patients with chemosensitive disease to bridging therapy (OR=0.375, P = .074). Age or PS was not associated with increased risk of bacterial infection. Increase in C-reactive protein (CRP) prior to fever onset was associated with microbiologically documented infections. We conclude that infections are common in the first month following CAR-T-cell administration, however, were not increased in elderly patients or those presenting with poorer PS. Increase in CRP prior to fever onset could support infection over cytokine release syndrome.
Keyphrases
- end stage renal disease
- diffuse large b cell lymphoma
- newly diagnosed
- ejection fraction
- chronic kidney disease
- gram negative
- prognostic factors
- induced apoptosis
- sars cov
- signaling pathway
- intensive care unit
- oxidative stress
- peritoneal dialysis
- immune response
- case report
- cancer therapy
- regulatory t cells
- acute respiratory distress syndrome
- mechanical ventilation