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Chimeric antigen receptor (CAR) T cells targeting the B-cell-specific antigen, CD19, has revolutionized the management and prognosis of patients with relapsing/refractory B-cell malignancies. Such patients often present immunosuppressed due to previous treatments and baseline malignancy. Lymphodepletion chemotherapy is administered prior to CAR T therapy, causing profound cytopenias and mucositis. Cytokine release syndrome (CRS) and immune effector cell-associated neurotoxicity syndrome (ICANS) are frequent complications, as is B-cell aplasia, prolonged hypogammaglobulinemia, and cytopenia. Infections in the first year after CAR T therapy are seen in up to 63% of patients with most infections being moderate or severe and occurring in the first month. Bacterial infections are most frequent, followed by viral and fungal infections. Risk factors for infection relate to both host and procedure factors such as secondary neutropenia, hypogammaglobulinemia, and secondary CRS/ICANS with their respective immunosuppressive treatments including corticosteroids and anti-inflammatory monoclonal antibodies.

DOI: 10.1007/978-3-031-11363-5_17