Infectious Complications of CAR T-Cell Therapy in Non-Hodgkin Lymphoma

Abstract

Chimeric Antigen Receptor T-Cell (CART) therapy is a promising therapeutic option for patients with relapsed, refractory lymphomas. Both immunosuppression and infections are complications reported in the post-CART setting. The objective of this study was to identify rates of infectious complications and febrile neutropenia at our institution. This retrospective single center study included 38 patients with relapsed, refractory non-Hodgkin lymphoma (NHL), who received CD19 directed CAR T-cell therapy axicabtagene ciloleucel, as standard of care for the treatment relapsed NHL between January, 2018 and October, 2019. Infectious complications were identified and classified as bacterial, viral, and either as non-invasive fungal or invasive fungal. We found that 79% (30/38) of patients experienced an episode of febrile neutropenia and 22 of the 46 identified infections occurred during an episode of neutropenia. Overall, 79% (30/38) of patients had an identified infection of viral, bacterial, or fungal. Sixteen patients (42%) were found to have bacterial infections, eight patients (21%) viral infections, and 17 (45%) fungal infections. Of the forty-six infections identified, 16 were bacterial, 11 viral, and 19 fungal. The most common sites of bacterial infections noted were blood stream infections (37.5%) and pulmonary (25%) sources. The most common viral infections identified were CMV (36%), BK virus (18%), and RSV (18%). The majority of the fungal infections identified were oral candidiasis (89.5%) with only 2 patients developing an invasive mold infection. Overall, we had notable infectious findings including a high incidence of non-invasive candidiasis and occurrences of opportunistic viral infections associated with CAR-T cell therapy and lymphodepletion as compared to the literature. There is a relative paucity of guidelines and literature on supportive cares as it relates to infectious complications. We ultimately conclude that infectious complications are common adverse effects of CAR-T therapy that require more robust investigation and further evidence-based and consensus driven guidelines.