Patterns of Infectious Complications in Patients With Myeloma After BCMA CAR T-Cell Therapy
Posted: Wednesday, November 17, 2021
Researchers at the University of California San Francisco (UCSF) Medical Center conducted a single-center retrospective analysis to investigate infectious complications among patients with multiple myeloma who received B-cell maturation antigen (BCMA)-targeted chimeric antigen receptor (CAR) T-cell therapy. Published in the journal Blood Advances, the study findings reported infections in more than half of patients after immunotherapy. Most were mild to moderate upper or lower respiratory infections.
“Based on these findings, we recommend antibacterial prophylaxis not only during early neutropenia but also with late or recurrent neutropenia and likely for at least 1 month post CAR T-cell therapy. We recommend varicella zoster virus prophylaxis for 6 months and Pneumocystis pneumonia prophylaxis for 3 months. Fluconazole prophylaxis should be tailored to patients’ risk for prolonged neutropenia,” stated Sandy W. Wong, MD, of the UCSF Helen Diller Family Comprehensive Care Center, and colleagues. The authors called for even larger studies to further assess this question, develop standard criteria for defining infections, and characterize underlying risk factors.
The study included 55 patients with multiple myeloma. The median age of patients was 62, and the median time from diagnosis was 6.8 years. In the first month post infusion, nearly all patients (98%) had grade 3 or 4 neutropenia. At 1 year post CAR T-cell therapy, most patients (76%) had hypogammaglobulinemia.
Patients were followed for a median of 6 months, and more than half (n = 29, 53%) had a clinical indication of infection. A total of 47 infection events were identified, including viral (53%), bacterial (40%), and fungal (6%). Most cases were mild to moderate (90%) and occurred in the lower/upper respiratory tract system (68%). Although the study did not identify significant risk factors, possible risk factors included prior lines of therapy, use of bridging chemotherapy, recent infections, and post CAR T-cell therapy lymphopenia.
Disclosure: Full authors’ disclosures are available at ashpublications.org.
