Infectious events by CAR-T targeta
| CAR-T target . | CD19 . | BCMA . | |||||||
|---|---|---|---|---|---|---|---|---|---|
| Study (patients on study) . | Wudhikarn et al 2020 (n = 59)12 . | Baird et al 2021 (n = 41)31 . | Logue et al 2021 (n = 85)7 . | Mikkilineni et al 2021 (n = 20)11 . | Hill et al 2018 (n = 133)14 . | Vora et al 2020 (n = 83)10 . | Mikkilineni et al 2021 (n = 24)11 . | Kambhampati et al 2022 (n = 55)13 . | Logue et al 2022 (n = 52)6 . |
| Disease | DLBCL | DLBCL | DLBCL | NHL | ALL/CLL/NHL | ALL | Multiple myeloma | Multiple myeloma | Multiple myeloma |
| Median follow-up | 12 months | ~19 months | 12 months | 1 month | 90 days | 90 days | 1 month | 6 months | 100 days |
| Infectious events in study period | 101 | 73 | 70 | 6 | 66 | 49 | 13 | 47 | 46 |
| Bacterial infections, n (%) | 60 (59) | 30 (41) | 37 (53) | 4 (67) | 32 (48) | 25 (51) | 9 (69) | 19 (40) | 27 (59) |
| Bacterial site infections, n (%) | 49 (49) | 29 (40) | 30 (43) | 3 (50) | 16 (24) | 6 (12) | 8 (62) | 14 (30) | 23 (50) |
| Bacteremia, n (%) | 11 (11) | 1 (1) | 7 (10) | 1 (17) | 16 (24) | 19 (39) | 1 (7) | 5 (10) | 4 (9) |
| Severe/life-threatening/ fatal (%) | 19 (19) | 13 (18) | 16 (23) | NR | NR | 22 (45) | NR | 3 (6) | NR |
| Viral infections, n (%) | 38 (38) | 28 (38) | 31 (44) | 2 (33) | 26 (39) | 23 (47) | 4 (31) | 25 (53) | 16 (35) |
| Respiratory virus, n (%) | 27 (27) | 14 (19) | 29 (41) | 0 (0) | 20 (30) | 21 (43) | 0 (0) | 25 (53) | 12 (26) |
| Other, n (%) | 11 (11) | 14 (19) | 2 (3) | 2 (33)# | 6 (9) | 2 (4) | 4 (31)# | 0 (0) | 4 (9) |
| Severe/life-threatening/ fatal (%) | 4 (4) | 4 (5) | 2 (3) | NR | NR | 4 (8) | NR | 0 (0) | NR |
| Fungal infection, n (%) | 2 (2) | 15 (21) | 2 (3) | 0 (0) | 8 (12) | 1 (2) | 0 (0) | 3 (6) | 3 (7) |
| Mold fungal, n (%) | 0 (0) | 1 (1) | 1 (1) | 0 (0) | 3 (5) | 1 (2) | 0 (0) | 2 (4) | 0 (0) |
| Nonmold fungal, n (%) | 2 (2) | 14 (20) | 1 (1) | 0 (0) | 5 (8) | 0 (0) | 0 (0) | 1 (2) | 3 (7) |
| Severe/life-threatening/ fatal (%) | 2 (2) | 5 (7) | 2 (3) | NR | NR | 1 (2) | NR | 1 (2) | NR |
| Special consideration | 2 cases of CMV reactivation were viremia without end-organ involvement in the setting of immunosuppression. 1 fatal viral infection with influenza A was reported. 1 patient had PJP pneumonia 4 months after stopping prophylaxis. | Cases of CMV occurred within 2 weeks of steroid initiation for CRS/ neurotoxicity. 3 cases of PJP occurred after stopping prophylaxis, resulting in 1 death. | 3 infection- related fatalities were caused by 2 cases of fungal infection and 1 case of Streptococcus mitis bacteremia. | Fungal infections were reassuringly rare. | 80% of early infections occurred within 10 days of CAR-T infusion. All patients who developed fungal infections had a prior HCT and/or developed severe CRS requiring immunosuppressive therapy. There were 3 CMV infections. | Median age of patients on this study was 12 years. Patients with previous HCT, hypogammaglobulinemia, and severe CRS may be at highest risk. | Prior lines of therapy and history of recent infection (within 100 days of LD chemo) compounded to increase risk of infection in first 30 days. | Viral infections predominated in this study. Most infections occurred in the first 100 days after CAR-T. | 14 severe infections reported across the first 100 days. |
| CAR-T target . | CD19 . | BCMA . | |||||||
|---|---|---|---|---|---|---|---|---|---|
| Study (patients on study) . | Wudhikarn et al 2020 (n = 59)12 . | Baird et al 2021 (n = 41)31 . | Logue et al 2021 (n = 85)7 . | Mikkilineni et al 2021 (n = 20)11 . | Hill et al 2018 (n = 133)14 . | Vora et al 2020 (n = 83)10 . | Mikkilineni et al 2021 (n = 24)11 . | Kambhampati et al 2022 (n = 55)13 . | Logue et al 2022 (n = 52)6 . |
| Disease | DLBCL | DLBCL | DLBCL | NHL | ALL/CLL/NHL | ALL | Multiple myeloma | Multiple myeloma | Multiple myeloma |
| Median follow-up | 12 months | ~19 months | 12 months | 1 month | 90 days | 90 days | 1 month | 6 months | 100 days |
| Infectious events in study period | 101 | 73 | 70 | 6 | 66 | 49 | 13 | 47 | 46 |
| Bacterial infections, n (%) | 60 (59) | 30 (41) | 37 (53) | 4 (67) | 32 (48) | 25 (51) | 9 (69) | 19 (40) | 27 (59) |
| Bacterial site infections, n (%) | 49 (49) | 29 (40) | 30 (43) | 3 (50) | 16 (24) | 6 (12) | 8 (62) | 14 (30) | 23 (50) |
| Bacteremia, n (%) | 11 (11) | 1 (1) | 7 (10) | 1 (17) | 16 (24) | 19 (39) | 1 (7) | 5 (10) | 4 (9) |
| Severe/life-threatening/ fatal (%) | 19 (19) | 13 (18) | 16 (23) | NR | NR | 22 (45) | NR | 3 (6) | NR |
| Viral infections, n (%) | 38 (38) | 28 (38) | 31 (44) | 2 (33) | 26 (39) | 23 (47) | 4 (31) | 25 (53) | 16 (35) |
| Respiratory virus, n (%) | 27 (27) | 14 (19) | 29 (41) | 0 (0) | 20 (30) | 21 (43) | 0 (0) | 25 (53) | 12 (26) |
| Other, n (%) | 11 (11) | 14 (19) | 2 (3) | 2 (33)# | 6 (9) | 2 (4) | 4 (31)# | 0 (0) | 4 (9) |
| Severe/life-threatening/ fatal (%) | 4 (4) | 4 (5) | 2 (3) | NR | NR | 4 (8) | NR | 0 (0) | NR |
| Fungal infection, n (%) | 2 (2) | 15 (21) | 2 (3) | 0 (0) | 8 (12) | 1 (2) | 0 (0) | 3 (6) | 3 (7) |
| Mold fungal, n (%) | 0 (0) | 1 (1) | 1 (1) | 0 (0) | 3 (5) | 1 (2) | 0 (0) | 2 (4) | 0 (0) |
| Nonmold fungal, n (%) | 2 (2) | 14 (20) | 1 (1) | 0 (0) | 5 (8) | 0 (0) | 0 (0) | 1 (2) | 3 (7) |
| Severe/life-threatening/ fatal (%) | 2 (2) | 5 (7) | 2 (3) | NR | NR | 1 (2) | NR | 1 (2) | NR |
| Special consideration | 2 cases of CMV reactivation were viremia without end-organ involvement in the setting of immunosuppression. 1 fatal viral infection with influenza A was reported. 1 patient had PJP pneumonia 4 months after stopping prophylaxis. | Cases of CMV occurred within 2 weeks of steroid initiation for CRS/ neurotoxicity. 3 cases of PJP occurred after stopping prophylaxis, resulting in 1 death. | 3 infection- related fatalities were caused by 2 cases of fungal infection and 1 case of Streptococcus mitis bacteremia. | Fungal infections were reassuringly rare. | 80% of early infections occurred within 10 days of CAR-T infusion. All patients who developed fungal infections had a prior HCT and/or developed severe CRS requiring immunosuppressive therapy. There were 3 CMV infections. | Median age of patients on this study was 12 years. Patients with previous HCT, hypogammaglobulinemia, and severe CRS may be at highest risk. | Prior lines of therapy and history of recent infection (within 100 days of LD chemo) compounded to increase risk of infection in first 30 days. | Viral infections predominated in this study. Most infections occurred in the first 100 days after CAR-T. | 14 severe infections reported across the first 100 days. |
Selected studies that reported infections with distinction between site of infection vs bacteremia, respiratory viruses vs other viruses, and mold vs nonmold fungal infections.
NR, not reported with specificity to bacterial, viral, fungal cause.
ALL, acute lymphoblastic leukemia; CLL, chronic lymphocytic leukemia; DLBCL, diffuse large B-cell lymphoma; NHL, non-Hodgkin lymphoma.