https://orcid.org/0000-0003-0717-0873
Key Points
Tailored infectious screening, including endemic pathogens, is critical in CAR-T candidates in endemic areas.
Abstract
Infectious complications remain a major concern after CAR-T cell therapy, particularly in low- and middle-income countries where endemic pathogens may increase risk. We retrospectively studied 23 patients with relapsed/refractory B-cell malignancies (18 diagnosed with Diffuse Large B-cell Lymphoma, three with Acute Lymphoblastic Leukemia, and two with Follicular Lymphoma) treated with CD19-directed CAR-T therapy (tisagenlecleucel or axicabtagene ciloleucel) at a single Brazilian center between February 2023 and January 2025. During a median follow-up of 124 days, 33 infectious episodes occurred, including 18 early (≤30 days) and 15 late (>30 days) events. Consistent with existing literature, the highest incidence was within the first month post-infusion, with bacterial infections, Candida spp, and CMV reactivation predominating, whereas respiratory viral infections were more frequent thereafter. Three patients developed endemic infections (tuberculosis, cryptococcosis, and giardiasis). CMV reactivation and probable aspergillosis were observed in 13% of patients each. Overall, 10 patients died, including 2 from infection and 8 from disease progression. A complementary literature review regarding endemic infections following CAR-T cell therapy was performed, highlighting tuberculosis, endemic fungal, and protozoan infections as important considerations for post-CAR-T management in endemic areas. Our findings emphasize the importance of early surveillance for infectious complications after CAR-T therapy, including attention to endemic pathogens in Latin America.
Author notes
Data Sharing Statement The datasets generated and/or analyzed during the current study are not publicly available due to patient confidentiality and institutional restrictions. However, data are available from the corresponding author upon reasonable request.
