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Review
. 2021 Apr;49(2):215-231.
doi: 10.1007/s15010-020-01521-5. Epub 2020 Sep 26.

Recommendations for screening, monitoring, prevention, and prophylaxis of infections in adult and pediatric patients receiving CAR T-cell therapy: a position paper

Ibai Los-Arcos  1   2 , Gloria Iacoboni  3   4 , Manuela Aguilar-Guisado  5 , Laia Alsina-Manrique  6 , Cristina Díaz de Heredia  7 , Claudia Fortuny-Guasch  8 , Irene García-Cadenas  9 , Carolina García-Vidal  10 , Marta González-Vicent  11 , Rafael Hernani  12 , Mi Kwon  13 , Marina Machado  14 , Xavier Martínez-Gómez  15 , Valentín Ortiz Maldonado  16   17 , Carolina Pinto Pla  18 , José Luis Piñana  19 , Virginia Pomar  20 , Juan Luis Reguera-Ortega  21 , Miguel Salavert  22 , Pere Soler-Palacín  23 , Lourdes Vázquez-López  24 , Pere Barba  25   26 , Isabel Ruiz-Camps  1   2
Affiliations
Review

Recommendations for screening, monitoring, prevention, and prophylaxis of infections in adult and pediatric patients receiving CAR T-cell therapy: a position paper

Ibai Los-Arcos et al. Infection. 2021 Apr.

Abstract

Chimeric antigen receptor (CAR) T-cell therapy is one of the most promising emerging treatments for B-cell malignancies. Recently, two CAR T-cell products (axicabtagene ciloleucel and tisagenlecleucel) have been approved for patients with aggressive B-cell lymphoma and acute lymphoblastic leukemia; many other CAR-T constructs are in research for both hematological and non-hematological diseases. Most of the patients receiving CAR-T therapy will develop fever at some point after infusion, mainly due to cytokine release syndrome (CRS). The onset of CRS is often indistinguishable from an infection, which makes management of these patients challenging. In addition to the lymphodepleting chemotherapy and CAR T cells, the treatment of complications with corticosteroids and/or tocilizumab increases the risk of infection in these patients. Data regarding incidence, risk factors and prevention of infections in patients receiving CAR-T cell therapy are scarce. To assist in patient care, a multidisciplinary team from hospitals designated by the Spanish Ministry of Health to perform CAR-T therapy prepared these recommendations. We reviewed the literature on the incidence, risk factors, and management of infections in adult and pediatric patients receiving CAR-T cell treatment. Recommendations cover different areas: monitoring and treatment of hypogammaglobulinemia, prevention, prophylaxis, and management of bacterial, viral, and fungal infections as well as vaccination prior and after CAR-T cell therapy.

Keywords: B-cell acute lymphoblastic leukemia; Bacterial infections; Chimeric antigen receptor; Diffuse large B-cell lymphoma; Fungal infections; Viral infections.

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Conflict of interest statement

ILA declares having received travel support from Gilead, MSD and Novartis, and speaker honoraria from Pfizer, outside the submitted work. GI declares honoraria from Gilead, Novartis, Roche and Celgene. CDH declares having received travel grants from MSD, Gilead, Novartis Jazz Pharmaceuticals, Consultancy de Novartis and Amgen, and speaker fees from Novartis, Jazz Pharmaceuticals and Sobi. JLRO received travel grants from Novartis, Gilead and Celgene. VOM is a recipient of a research grant (FEHH), travel grants (Kite, Celgene, Novartis, Roche, Takeda & Janssen), consultant or advisory fees (Kite, Celgene, Novartis) and honoraria (Kite). PSP reports grants, personal fees and non-financial support from Gilead, Pfizer, MSD and Astellas Pharma, outside the submitted work. PB declares having received honoraria from Amgen, Celgene, Gilead, Incyte, Jazz Pharmaceuticals, MSD, Novartis, Pfizer and Roche, not related with the present article. IRC declares having received honoraria from, Celgene, Gilead, MSD, Astellas, Novartis, and Pfizer outside the submitted work. The rest of the authors declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
Risk factors for infection in patients receiving CAR T cells
See this image and copyright information in PMC

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