Noninvasive candidiasis, viral infections common after CAR T-cell therapy
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ORLANDO — Infectious complications such as noninvasive candidiasis and opportunistic viral infections appeared to be common adverse effects of chimeric antigen receptor T-cell therapy among patients with relapsed or refractory non-Hodgkin lymphoma, according to results of a retrospective study presented at TCT | Transplantation & Cellular Therapy Meetings.
These complications warrant more robust investigations, as well as evidence-based and consensus-driven guidelines, researchers noted.
“We were very surprised by the rate of fungal infections we saw, including noninvasive candidiasis,” Justin Hayne, PA-C, MS, physician assistant at Mayo Clinic in Rochester, Minnesota, told Healio. “We did not use any antifungal prophylaxis routinely when we first began this study, but we changed that about three-quarters through this data set. We will follow up to see if that had any effect.”
Two CAR T-cell therapies, axicabtagene ciloleucel (Yescarta, Kite Pharmaceuticals) and tisagenlecleucel (Kymriah, Novartis), have been approved for certain patients with lymphoma. Complications reported after treatment with CAR T-cell therapy include immunosuppression and infections.
In their single-center study, Hayne and colleagues retrospectively analyzed rates of infectious complications and febrile neutropenia among 38 patients (age range, 30-74 years; 68.4% men) with relapsed or refractory non-Hodgkin lymphoma who received axicabtagene ciloleucel, which targets CD19, between January 2018 and October 2019. Half of patients (n = 19) had diffuse large B-cell lymphoma, whereas 34% (n = 13) had transformed follicular lymphoma, 13% (n = 5) had high-grade lymphoma and 2.6% (n = 1) had primary mediastinal large B-cell lymphoma.
Researchers classified infectious complications as bacterial, viral, noninvasive fungal or invasive fungal.
Results showed 79% (n = 30) of patients experienced a viral (n = 8), bacterial (n = 16) or fungal (n = 17) infection after CAR T-cell therapy.
Of the 46 infections observed overall, 16 were bacterial, 11 were viral and 19 were fungal.
Common sites of bacterial infections included the bloodstream (37.5%) and pulmonary sources (25%). Common viral infections included cytomegalovirus (36%), BK virus (18%) and respiratory syncytial virus (18%).
Most fungal infections were oral candidiasis (89.5%). Two patients developed an invasive mold infection.
Additionally, 30 patients (79%) experienced an episode of febrile neutropenia. Of the 46 infections identified, 22 (47.8%) occurred during a neutropenic episode.
“We were very broad with the use of antibiotics until the patient started to get better,” Hayne told Healio. “We then specifically targeted any bacterial infection we saw after that.” – by John DeRosier
Reference:
Hayne J, et al. Abstract 415. Presented at: TCT | Transplantation & Cellular Therapy Meetings; Feb. 19, 2020; Orlando.
Disclosures: Hayne reports no relevant financial disclosures. Please see the abstract for all other authors’ relevant financial disclosures.