Chimeric antigen receptor (CAR) T-cell therapy is a rapidly emerging treatment option for patients with B-cell malignancies. Many patients who receive CAR T-cell therapy develop a fever, often due to cytokine release syndrome (CRS). However, it can be difficult for clinicians to differentiate between fever from CRS and fever from infection. This is an important area of clinical management because people with B-cell malignancies are usually at higher risk of infection due to chemotherapy, corticosteroids and other factors.
An article recently published in Infection provides guidance on the screening, monitoring, and prevention of infections in adult and pediatric patients receiving CAR T-cell therapy. The authors were a multidisciplinary group of clinicians from hospitals designated by the Spanish Ministry of Health. Lead author was Ibai Los-Arcos from the Infectious Diseases Department at the Hospital Universitari Vall D’Hebron in Barcelona, Spain.
The authors conducted a literature review to elucidate incidence, risk factors, and management of infections in adult and pediatric patients receiving CAR-T cell therapy. Based on their findings, they offered extensive recommendations for adult patients and for pediatric patients regarding:
- monitoring and treating hypogammaglobulinemia
- preventing and managing bacterial, viral, and fungal infections
- vaccination before and after CAR-T cell therapy
They identified specific factors closely associated with infections, and they encouraged clinicians to be vigilant for certain populations at risk:
- B-cell aplasia/hypogammaglobulinemia
- impaired cellular immunity
- use of tocilizumab and/or corticosteroids for the treatment of CRS or neurotoxicity
Regarding vaccination, the authors recommended no inactivated vaccines until three months after cell infusion and no attenuated vaccines for 24 months post-therapy. The authors also recommended that clinicians encourage immunization of patients’ immediate family members and healthcare professionals to confer extra protection to people receiving CAR T-cell therapy.