Cited by 75CAR-T cell therapy researchNeutropenia and Cancer InfectionsImmunodeficiency and Autoimmune Disorders

Infectious complications of CAR T-cell therapy across novel antigen targets in the first 30 days

Open access
Mikkilineni, Lekha, Yates, Bonnie, Steinberg, Seth M., Shahani, Shilpa A., Molina, John C., Palmore, Tara, Lee, Daniel W., Kaplan, Rosandra N. +7 more·2021·Blood Advances

Abstract

Infections are a known complication of chimeric antigen receptor (CAR) T-cell therapy with data largely emerging from CD19 CAR T-cell targeting. As CAR T-cell therapy continues to evolve, infection risks and management thereof will become increasingly important to optimize outcomes across the spectrum of antigens and disease targeted. We retrospectively characterized infectious complications occurring in 162 children and adults treated among 5 phase 1 CAR T-cell clinical trials. Trials included targeting of CD19, CD22, disialoganglioside (GD2) or B-cell maturation antigen (BCMA). Fifty-three patients (32.7%) had 76 infections between lymphocyte depleting (LD) chemotherapy and day 30 (D30); with the majority of infections (61, 80.3%) occurring between day 0 (D0) and D30. By trial, the highest proportion of infections was seen with CD22 CAR T cells (n = 23/53; 43.4%), followed by BCMA CAR T cells (n = 9/24; 37.5%). By disease, patients with multiple myeloma had the highest proportion of infections (9/24; 37.5%) followed by acute lymphoblastic leukemia (36/102; 35.3%). Grade 4 infections were rare (n = 4; 2.5%). Between D0 and D30, bacteremia and bacterial site infections were the most common infection type. In univariate analysis, increasing prior lines of therapy, recent infection within 100 days of LD chemotherapy, corticosteroid or tocilizumab use, and fever and neutropenia were associated with a higher risk of infection. In a multivariable analysis, only prior lines of therapy and recent infection were associated with higher risk of infection. In conclusion, we provide a broad overview of infection risk within the first 30 days post infusion across a host of multiple targets and diseases, elucidating both unique characteristics and commonalities highlighting aspects important to improving patient outcomes.

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Crossref · 10.1182/bloodadvances.2021004896

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  • BCMA-targeted T-cell-redirecting therapies have been linked to a heightened susceptibility to infectious complications due to their mechanism of action.

    “BCMA-targeted T-cell-redirecting therapies have been linked to a heightened susceptibility to infectious complications due to their mechanism of action30–33.”

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Authors
Mikkilineni, L., Yates, B., Steinberg, S. M., Shahani, S. A., Molina, J. C., Palmore, T., Lee, D. W., Kaplan, R. N., Mackall, C. L., Fry, T. J., Gea-Banacloche, J., Jerussi, T., Nussenblatt, V., Kochenderfer, J. N., & Shah, N. N.
Affiliations
  • National Cancer Institute (MY)
  • National Cancer Institute (UA)
  • National Institutes of Health (US)
  • Children's Hospital Colorado (US)
  • Division of Clinical Research, National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH), Bethesda, MD; and
Venue
Blood Advances
Published
2021-12-08
Volume
5
Issue
23
Pages
5312-5322
ISSN
  • 2473-9529 (ISSN-L)
  • 2473-9537
OpenAlex
W3204393409
Cited by
75
References
28
Citations by year
2026: 15 · 2025: 17 · 2024: 20 · 2023: 13 · 2022: 10
FWCI
3.92
Type
journal article
Language
en
Open access
Licence
cc-by-nc-nd
Locations
  • Blood Advances (publishedVersion, cc-by-nc-nd)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
Funders
  • National Institutes of Health
  • National Cancer Institute
  • NIH Clinical Center
Topics
  • Health Sciences › Medicine › Oncology › CAR-T cell therapy research
  • Health Sciences › Medicine › Oncology › Neutropenia and Cancer Infections
  • Life Sciences › Immunology and Microbiology › Immunology › Immunodeficiency and Autoimmune Disorders
Keywords
CAR T-cell therapy, infectious complications, CD22, BCMA, GD2, CD19, multiple myeloma, acute lymphoblastic leukemia, bacteremia, infection risk factors, prior lines of therapy, tocilizumab, corticosteroids, neutropenia
MeSH terms
Humans, Multiple Myeloma, Retrospective Studies, T-Lymphocytes, Immunotherapy, Adoptive, Antigens, CD19

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