Infection Complications after Lymphodepletion and Dosing of Chimeric Antigen Receptor T (CAR-T) Cell Therapy in Patients with Relapsed/Refractory Acute Lymphoblastic Leukemia or B Cell Non-Hodgkin Lymphoma
Chimeric antigen receptor T (CAR-T) cell therapy has proven to be very effective in patients with relapsed/refractory acute lymphoblastic leukemia (ALL) and non-Hodgkin lymphoma (NHL). However, infections—related either due to lymphodepletion or the CAR-T cell therapy itself—can result in severe and...
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MDPI AG
2021-04-01
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| Online Access: | https://www.mdpi.com/2072-6694/13/7/1684 |
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| author | Felix Korell Maria-Luisa Schubert Tim Sauer Anita Schmitt Patrick Derigs Tim Frederik Weber Paul Schnitzler Carsten Müller-Tidow Peter Dreger Michael Schmitt |
| author_facet | Felix Korell Maria-Luisa Schubert Tim Sauer Anita Schmitt Patrick Derigs Tim Frederik Weber Paul Schnitzler Carsten Müller-Tidow Peter Dreger Michael Schmitt |
| author_sort | Felix Korell |
| collection | DOAJ |
| description | Chimeric antigen receptor T (CAR-T) cell therapy has proven to be very effective in patients with relapsed/refractory acute lymphoblastic leukemia (ALL) and non-Hodgkin lymphoma (NHL). However, infections—related either due to lymphodepletion or the CAR-T cell therapy itself—can result in severe and potentially life-threatening complications, while side effects such as cytokine release syndrome (CRS) might complicate differential diagnosis. Sixty-seven dosings of CAR-T cells in sixty adult patients with NHL (85%) and ALL (15%) receiving CAR-T cell therapy were assessed for infectious complications. Almost two-thirds of patients (61%) developed fever following lymphodepletion and CAR-T cell dosing. Microbiological or radiological findings were observed in 25% of all cases (bacterial 12%, viral 5%, fungal 8%). Inpatient infections were associated with more lines of therapy and more severe CRS. However, overall serious complications were rare after CAR-T therapy, with one patient dying of infection. Pathogen detection after inpatient stay was infrequent and mostly occurred in the first 90 days after dosing. Infections in CAR-T cell treated patents are common. Fast and suitable identification and treatment are crucial in these heavily pretreated and immunocompromised patients. In most cases infectious complications are manageable. Nonetheless, standardized anti-infective prophylaxis and supportive therapy are mandatory to reduce morbidity and mortality in CAR-T cell therapy. |
| first_indexed | 2024-03-10T12:39:56Z |
| format | Article |
| id | doaj.art-ba252330e8a54382b52a1c2bebf5df75 |
| institution | Directory Open Access Journal |
| issn | 2072-6694 |
| language | English |
| last_indexed | 2024-03-10T12:39:56Z |
| publishDate | 2021-04-01 |
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| record_format | Article |
| series | Cancers |
| spelling | doaj.art-ba252330e8a54382b52a1c2bebf5df752023-11-21T14:01:24ZengMDPI AGCancers2072-66942021-04-01137168410.3390/cancers13071684Infection Complications after Lymphodepletion and Dosing of Chimeric Antigen Receptor T (CAR-T) Cell Therapy in Patients with Relapsed/Refractory Acute Lymphoblastic Leukemia or B Cell Non-Hodgkin LymphomaFelix Korell0Maria-Luisa Schubert1Tim Sauer2Anita Schmitt3Patrick Derigs4Tim Frederik Weber5Paul Schnitzler6Carsten Müller-Tidow7Peter Dreger8Michael Schmitt9Department of Internal Medicine V—Hematology, Oncology & Rheumatology, University Hospital Heidelberg, 69120 Heidelberg, GermanyDepartment of Internal Medicine V—Hematology, Oncology & Rheumatology, University Hospital Heidelberg, 69120 Heidelberg, GermanyDepartment of Internal Medicine V—Hematology, Oncology & Rheumatology, University Hospital Heidelberg, 69120 Heidelberg, GermanyDepartment of Internal Medicine V—Hematology, Oncology & Rheumatology, University Hospital Heidelberg, 69120 Heidelberg, GermanyDepartment of Internal Medicine V—Hematology, Oncology & Rheumatology, University Hospital Heidelberg, 69120 Heidelberg, GermanyDepartment of Diagnostic and Interventional Radiology, University Hospital Heidelberg, 69120 Heidelberg, GermanyDepartment of Virology, University Hospital Heidelberg, 69120 Heidelberg, GermanyDepartment of Internal Medicine V—Hematology, Oncology & Rheumatology, University Hospital Heidelberg, 69120 Heidelberg, GermanyDepartment of Internal Medicine V—Hematology, Oncology & Rheumatology, University Hospital Heidelberg, 69120 Heidelberg, GermanyDepartment of Internal Medicine V—Hematology, Oncology & Rheumatology, University Hospital Heidelberg, 69120 Heidelberg, GermanyChimeric antigen receptor T (CAR-T) cell therapy has proven to be very effective in patients with relapsed/refractory acute lymphoblastic leukemia (ALL) and non-Hodgkin lymphoma (NHL). However, infections—related either due to lymphodepletion or the CAR-T cell therapy itself—can result in severe and potentially life-threatening complications, while side effects such as cytokine release syndrome (CRS) might complicate differential diagnosis. Sixty-seven dosings of CAR-T cells in sixty adult patients with NHL (85%) and ALL (15%) receiving CAR-T cell therapy were assessed for infectious complications. Almost two-thirds of patients (61%) developed fever following lymphodepletion and CAR-T cell dosing. Microbiological or radiological findings were observed in 25% of all cases (bacterial 12%, viral 5%, fungal 8%). Inpatient infections were associated with more lines of therapy and more severe CRS. However, overall serious complications were rare after CAR-T therapy, with one patient dying of infection. Pathogen detection after inpatient stay was infrequent and mostly occurred in the first 90 days after dosing. Infections in CAR-T cell treated patents are common. Fast and suitable identification and treatment are crucial in these heavily pretreated and immunocompromised patients. In most cases infectious complications are manageable. Nonetheless, standardized anti-infective prophylaxis and supportive therapy are mandatory to reduce morbidity and mortality in CAR-T cell therapy.https://www.mdpi.com/2072-6694/13/7/1684CAR-T cellinfectionlymphodepletioncytokine release syndrome |
| spellingShingle | Felix Korell Maria-Luisa Schubert Tim Sauer Anita Schmitt Patrick Derigs Tim Frederik Weber Paul Schnitzler Carsten Müller-Tidow Peter Dreger Michael Schmitt Infection Complications after Lymphodepletion and Dosing of Chimeric Antigen Receptor T (CAR-T) Cell Therapy in Patients with Relapsed/Refractory Acute Lymphoblastic Leukemia or B Cell Non-Hodgkin Lymphoma Cancers CAR-T cell infection lymphodepletion cytokine release syndrome |
| title | Infection Complications after Lymphodepletion and Dosing of Chimeric Antigen Receptor T (CAR-T) Cell Therapy in Patients with Relapsed/Refractory Acute Lymphoblastic Leukemia or B Cell Non-Hodgkin Lymphoma |
| title_full | Infection Complications after Lymphodepletion and Dosing of Chimeric Antigen Receptor T (CAR-T) Cell Therapy in Patients with Relapsed/Refractory Acute Lymphoblastic Leukemia or B Cell Non-Hodgkin Lymphoma |
| title_fullStr | Infection Complications after Lymphodepletion and Dosing of Chimeric Antigen Receptor T (CAR-T) Cell Therapy in Patients with Relapsed/Refractory Acute Lymphoblastic Leukemia or B Cell Non-Hodgkin Lymphoma |
| title_full_unstemmed | Infection Complications after Lymphodepletion and Dosing of Chimeric Antigen Receptor T (CAR-T) Cell Therapy in Patients with Relapsed/Refractory Acute Lymphoblastic Leukemia or B Cell Non-Hodgkin Lymphoma |
| title_short | Infection Complications after Lymphodepletion and Dosing of Chimeric Antigen Receptor T (CAR-T) Cell Therapy in Patients with Relapsed/Refractory Acute Lymphoblastic Leukemia or B Cell Non-Hodgkin Lymphoma |
| title_sort | infection complications after lymphodepletion and dosing of chimeric antigen receptor t car t cell therapy in patients with relapsed refractory acute lymphoblastic leukemia or b cell non hodgkin lymphoma |
| topic | CAR-T cell infection lymphodepletion cytokine release syndrome |
| url | https://www.mdpi.com/2072-6694/13/7/1684 |
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