Infectious diseases screening prior to CD19-targeted CAR–T-cell therapy
| Screening for infectious diseases . |
|---|
| Required |
| HIV using the fourth-generation antigen/antibody combination HIV-1/2 immunoassay* |
| HBsAg, anti-HBs, and anti-HBc* |
| HCV IgG* |
| Consider† |
| HSV-1 and HSV-2 IgG‡ |
| VZV IgG |
| CMV IgG |
| HTLV-1 IgG |
| Toxoplasma gondii IgG |
| Treponema pallidum (syphilis) treponemal or nontreponemal test |
| M tuberculosis skin test and/or blood interferon-γ release assay§ |
| S stercoralis IgG or empiric treatment§ |
| Screening for infectious diseases . |
|---|
| Required |
| HIV using the fourth-generation antigen/antibody combination HIV-1/2 immunoassay* |
| HBsAg, anti-HBs, and anti-HBc* |
| HCV IgG* |
| Consider† |
| HSV-1 and HSV-2 IgG‡ |
| VZV IgG |
| CMV IgG |
| HTLV-1 IgG |
| Toxoplasma gondii IgG |
| Treponema pallidum (syphilis) treponemal or nontreponemal test |
| M tuberculosis skin test and/or blood interferon-γ release assay§ |
| S stercoralis IgG or empiric treatment§ |
If positive, perform reflex nucleic acid testing.
Screening for these pathogens may impact antimicrobial prophylaxis strategies and are routinely performed in the context of donor and recipient evaluations for HCT or solid organ transplantation.35,74 Additional risk factors in CD19-targeted CAR–T-cell therapy recipients, such as high-dose corticosteroids and tocilizumab for CRS or ICANS, may increase risk for reactivation of latent infections such as M tuberculosis and S stercoralis. Given that latent infection may be asymptomatic, and symptoms of reactivation are often nonspecific, screening may improve risk stratification and identification of infections after CAR–T-cell therapy.
Patients not already receiving antiviral prophylaxis for herpesviruses should have serologic screening; if positive, they should be started on antiviral prophylaxis as per FAQ 4.
In patients with risk factors for exposure.