Post–CAR T-Cell Infections Linked to Higher Mortality in LBCL, Study Finds

Investigators at the Center for International Blood and Marrow Transplant Research (CIBMTR) analyzed risk factors and outcomes in patients with relapsed/refractory (R/R) large B-cell lymphoma (LBCL) after receiving CAR T-cell therapy. LBCL, which accounts for 85% of all lymphomas in the United States, according to the MD Anderson Cancer Center. Early symptoms include night sweats and unexplained weight loss.

The researchers from CINMTR analyzed the medical records of 3,350 patients receiving CD19 CAR T-cell therapy, which harnesses the power of a person’s immune system to target and destroy cancer cells that express the CD19 protein. Of those, 2,804 received axicabtagene ciloleucel and 546 received a different CAR T-cell therapy, tisagenlecleucel, from December 2017 to June 2022. Nearly a quarter (24.9%) of patients developed various types of infections within 100 days of receiving the infusion. Bacterial infections occurred in 527 (15.7%), viral infections occurred in 374 (11.2%), and fungal infections occurred in 108 (3.2%) patients.

Patients with a severe cytokine release syndrome grade 3 or higher were at an increased risk of infection. Other risk factors include advanced age, a history of prior treatments, and a neutrophil count that failed to recover. After the median follow-up of 24 months, 44% patients died. Infection was the cause of death in 12% of patients. At 100 days, death from infection was 1.6% (95% CI, 1.2%-2.0%). Principal investigator Kitsada Wudhikarn, MD, and colleagues published the findings in Blood Advances.

Patients with a Karnofsky Performance score of 80 or less were more prone to infection. The scale, which ranges from 0 to 100, defines criteria about how people can carry on with normal activities like work and personal care. A score of 80 or less indicates the person is unable to work but may be able to care for their personal needs and may need some help, according to the National Palliative Care Research Center.

These findings could help tailor infection prevention strategies and potentially improve patient outcomes following CAR T-cell therapy. Further research will help researchers learn more about the short-term and long-term side effects of these treatments, which can affect overall survival.