Infectious Complications of CD19-targeted Chimeric Antigen Receptor T-cell Therapy: a Multicenter Cohort Study.

BACKGROUND: Our understanding of the epidemiology of and risk factors for postchimeric antigen receptor T-cell therapy (CART) infections is largely based on data from single-center studies with small sample sizes. METHODS: This is a multicenter, cohort study of adult patients treated with CD19 CART between 1 January 2018 and 31 August 2021. The epidemiology of infectious complications occurring within the first year after CART is described. A Fine-Gray subdistribution hazard model was built to identify risk factors for infection. Logistic regression was used to explore risk factors for early (≤90 days post-CART) versus late (>90 days post-CART) and bacterial versus viral infection. RESULTS: One hundred and thirty-one infections occurred in 97 of 311 patients (31.2%) within 1 year of CART. By infection type, the cumulative incidence of infection was 19.0% (viral), 20.9% (bacterial), and 2.3% (fungal). The majority of infections were mild or moderate in severity (86%). Clostridiodes difficile and bloodstream infections due to Gram-negative bacilli were common bacterial infections. Respiratory viral infections were the most common viral complication and fungal infections were rare. No independent predictors of infection were identified. CONCLUSIONS: Infectious complications occur in close to a third of patients post-CART but are generally mild in severity. Though we were not able to identify independent predictors of post-CART infection, a description of their clinical characteristics and epidemiology will help to optimize management of these common complications.

Duke Scholars

Author Julia Antoinette Messina Medicine, Infectious Diseases

Author Patrick Chung Kay Tam Medicine, Infectious Diseases

Author Taewoong Choi Medicine, Hematologic Malignancies and Cellular Therapy

Author Matthew Stuart McKinney Medicine, Hematologic Malignancies and Cellular Therapy

Author Christopher Ryan Kelsey Radiation Oncology