Infectious Challenges with Novel Antibody–Based Therapies

Abstract

The development of new antibody-based therapies has changed the landscape of the treatment of malignancies and improved post-transplant outcomes for transplant recipients. Use of these new therapies has led to recognition of unintended, potentially serious infectious complications. This review seeks to provide an overview of the infectious risks of these agents and assist clinicians in how to address them. Due to its profound depletion of B- and T-lymphocytes, alemtuzumab increases the risk of viral reactivation and other intracellular pathogens. Anti-CD20 agents increase the risk of hepatitis B virus reactivation and carry the risk of progressive multifocal leukoencephalopathy. Immune checkpoint inhibitors can cause immune-related adverse events that can masquerade as infections. Eculizumab increases the risk of Neisseria infections. Brentuximab vedotin appears to increase the overall risk of infection, though no specific prophylaxis strategies are recommended. Belatacept increases the risk of post-transplant lymphoproliferative disorders and Pneumocystis jirovecii pneumonia. While improving outcomes and survival, novel therapies may have off-target effects, increasing the risk of bacterial, viral, and fungal infections. Clinicians must be aware of potential infectious complications and take measures to screen for latent infections, provide immunizations, and provide chemoprophylaxis (as indicated). Clinicians also need to be aware of potential non-infectious, inflammatory autoimmune complications of these agents that could present similarly to infection. Multi-disciplinary and multi-institutional research is needed to better define the association between these therapies and infection, and develop protocols to reduce infectious risk.