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Clinical Trial
. 2021 Oct 18;11(10):168.
doi: 10.1038/s41408-021-00563-8.

Viral infection/reactivation during long-term follow-up in multiple myeloma patients with anti-BCMA CAR therapy

Di Wang #  1   2 , Xia Mao #  1   2 , Yimei Que  1   2 , Menglei Xu  1   2 , Yuhang Cheng  1   2 , Liang Huang  1   2 , Jue Wang  1   2 , Yi Xiao  1   2 , Wen Wang  3 , Guang Hu  3 , Shangkun Zhang  4   5 , Tongcun Zhang  4   5 , Chunrui Li  6   7 , Jianfeng Zhou  8   9
Affiliations
Clinical Trial

Viral infection/reactivation during long-term follow-up in multiple myeloma patients with anti-BCMA CAR therapy

Di Wang et al. Blood Cancer J. .
No abstract available

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Conflict of interest statement

G.H. and J.Z. are among inventors of patent applications related to the CT103A. W.W. and G.H. are employees of Nanjing IASO Therapeutics Ltd. and held interests in the company. J.Z. is a nonpaid member of the Scientific and Medical Advisory Board of Nanjing IASO Therapeutics Ltd. S.Z. and T.Z. are employees of Wuhan Bio‐Raid Biotechnology Co., Ltd. and held interests in the company. All other authors declare no competing interests.

Figures

Fig. 1
Fig. 1. Viral infections, changes of immune system, and recommendations of viral management in patients receiving BCMA-targeting CAR T-cell therapy.
A All infection events detected from screening till the data cut-off date or last follow-up are shown; each symbol represents a virus type. The blue and purple bars represent the overall survival of patients receiving mouse- and fully human-originate anti-BCMA CAR, respectively. The viral DNA replication detected at screening was marked on the baseline, including one HBV, one CMV, and eight EBV cases. After anti-BCMA CAR T-cell infusion, 18 viral infection/reactivation events were recorded, including four EBV, six CMV, three HBV, four herpes zoster, and one COVID-19 case. Most events were recorded within the first 6 months post infusion. B The percentage of lymphocyte subpopulations, including T cells, B cells, and NK cells, was analyzed by flow cytometry. B cells and NK cells fell to the nadir at the first and the third months post infusion, respectively, while T cells peaked at 3 months post infusion. The bar at each point represents the standard error of the mean. C BCMA CAR transgene and immunoglobulin levels in patients were tested post infusion. BCMA CAR transgene reached the peak at the first months, which was parallel with the depletion of B cells. Decrease of immunoglobulin fell behind the B cells depletion and recovered from the sixth month. The bar at each point represents the standard error of the mean. D At the time of patient enrollment, screening tests of common viruses, such as HBV, HCV, HIV, CMV, and EBV, would be needed. Regular monitoring of viral nucleic acid after anti-BCMA CAR infusion is recommended. Long-time entecavir prophylaxis is necessary for patients with HBV infection, and acyclovir prophylaxis is recommended for all patients. Immunoglobulin replacement is preferred for patients with IgG ≤ 400 mg/dL or symptomatic infection. Antiviral treatment would be needed immediately after positive viral findings except for EBV. Abbreviations: CMV, cytomegalovirus; EBV, Epstein-Barr virus; HBV/HCV, hepatitis B/C virus; HIV, human immunodeficiency virus; IG, Immunoglobulin. *Only patients who are confirmed with HBV infection (including chronic and resolved infection) need regular monitoring of viral nucleic acid post infusion.
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References

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