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Infection Risk Up in Month After CAR T-Cell Immunotherapy

Infection rates increase in patients with ALL aged ≤26 years in first month, then decrease at days 29 to 90

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FRIDAY, May 29, 2020 (HealthDay News) -- For children and young adults receiving CD19 chimeric antigen receptor (CAR) T-cell infusion (CTI), infection rates increase in the first month after treatment and then decrease, according to a study published in the May issue of Open Forum Infectious Diseases.

Surabhi B. Vora, M.D., M.P.H., from the University of Washington in Seattle, and colleagues reviewed the medical records of 83 patients ≤26 years receiving CTI at a single institution between 2014 and 2017. The number of infections per 100 days at risk was calculated in the 90 days preceding and 0 to 28 and 29 to 90 days after CTI.

The researchers found that 98 percent of patients had refractory or relapsed acute lymphoblastic leukemia. In the 90 days before CTI, infections occurred in 54 percent of patients (infection density, 1.23) compared with 40 percent of patients in the 28 days following CTI (infection density, 2.89). In the 29 to 90 days after CTI, infection density decreased to 0.55. Most infections were bacteremias or respiratory viral infections (39 and 43 percent, respectively). Prior hematopoietic cell transplantation, immunoglobulin G (IgG) level <400 mg/dL, and lymphodepletion other than cyclophosphamide plus fludarabine were pre-CTI risk factors associated with infection; higher-severity cytokine release syndrome and IgG <400 mg/dL were post-CTI risk factors.

"Our results suggest that viral, bacterial, and fungal prophylaxis and lymphodepletion regimens need to be carefully considered in the setting of CAR T-cell therapy," the authors write.

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