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Curated Papers > High-impact authoritative literature on "CAR-T therapy"

CAR-T cell therapy and infection: a review. ​

Literature Information ​

DOI10.1080/14787210.2021.1855143
PMID33249873
JournalExpert review of anti-infective therapy
Impact Factor3.8
JCR QuartileQ1
Publication Year2021
Times Cited44
KeywordsCAR-T cell therapy, antimicrobial prophylaxis, hematological malignancy, infection, infection prevention
Literature TypeJournal Article, Review
ISSN1478-7210
Pages749-758
Issue19(6)
AuthorsOlivia Bupha-Intr, Gabrielle Haeusler, Lynette Chee, Karin Thursky, Monica Slavin, Benjamin Teh

TL;DR ​

This narrative review highlights the increased infection risks faced by patients undergoing chimeric antigen receptor T-cell therapy (CAR-T), attributed to factors such as prior immunosuppression and prolonged cytopenias, while also discussing potential infection prevention strategies. The findings underscore the need for ongoing surveillance and effective management of infectious complications to ensure the safety and efficacy of this promising cancer treatment.

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CAR-T cell therapy · antimicrobial prophylaxis · hematological malignancy · infection · infection prevention

Abstract ​

Introduction: Chimeric antigen receptor T-cell therapy (CAR-T cell therapy) is a novel immunotherapy with promising results in the treatment of relapsed or refractory B cell malignancies. Patients undergoing CAR-T cell therapy are at increased risk of infection due to prior immunosuppression, lymphodepleting chemotherapy, treatment of unique toxicities with tocilizumab and/or steroids, on-target effects of hypogammaglobulinaemia, and prolonged cytopenias.Areas covered: A narrative review of infections (PubMed, August 2020) occurring in patients undergoing CAR-T cell therapy is described, and the evidence for infection prevention strategies is presented.Expert commentary: The rapid adoption of CAR-T cell therapy into clinical practice presents many challenges for the diagnosis, management, and prevention of infection. Ongoing surveillance of the spectrum of infectious complications and effectiveness of prophylaxis is required to support safe and effective patient care.

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Primary Questions Addressed ​

  1. What specific types of infections are most commonly observed in patients receiving CAR-T cell therapy?
  2. How do different immunosuppressive treatments prior to CAR-T cell therapy influence the risk of infection?
  3. What role do prophylactic antibiotics play in the management of infection risk during CAR-T cell therapy?
  4. How can healthcare providers improve monitoring and early detection of infections in patients undergoing CAR-T cell therapy?
  5. What are the long-term implications of infections on the overall outcomes and survival rates of patients treated with CAR-T cell therapy?

Key Findings ​

1. Research Background and Purpose: Chimeric antigen receptor T-cell (CAR-T) therapy has emerged as a groundbreaking immunotherapeutic approach for treating relapsed or refractory B cell malignancies. Despite its remarkable efficacy, patients undergoing CAR-T therapy face a heightened risk of infections due to several factors, including previous immunosuppressive treatments, lymphodepleting chemotherapy, and the management of associated toxicities with agents like tocilizumab and corticosteroids. Additionally, the therapy's on-target effects can lead to conditions such as hypogammaglobulinaemia and prolonged cytopenias, further complicating the infection landscape. This review aims to comprehensively analyze the types of infections that occur in CAR-T therapy patients and to evaluate strategies for infection prevention.

2. Main Methods and Findings: The authors conducted a narrative review by sourcing literature from PubMed up to August 2020, focusing on infections associated with CAR-T cell therapy. The review systematically detailed various infectious complications encountered by these patients, emphasizing the need for vigilant monitoring and proactive management. Key findings indicate that patients are susceptible to a broad spectrum of infections, both opportunistic and non-opportunistic, due to the immunocompromised state induced by the therapy. The authors also highlighted current prophylactic strategies and their effectiveness in mitigating infection risks.

3. Core Conclusion: The review concludes that while CAR-T cell therapy demonstrates significant therapeutic potential, it also introduces substantial risks for infection that must be addressed. Effective infection prevention strategies are crucial for improving patient outcomes and minimizing complications. Ongoing research and surveillance into the types of infections experienced by CAR-T patients and the efficacy of prophylactic measures are essential to enhance overall patient care and safety.

4. Research Significance and Impact: This review is significant as it underscores the dual nature of CAR-T therapy, offering hope for patients with challenging malignancies while simultaneously presenting new clinical challenges, particularly concerning infectious complications. By identifying the risks and advocating for comprehensive infection management protocols, the study contributes to the ongoing discourse on optimizing CAR-T therapy. It emphasizes the need for healthcare providers to remain vigilant and adapt their treatment strategies for infection prevention, thus impacting clinical practice and patient safety in the burgeoning field of CAR-T therapy. The insights gained from this review are foundational for future studies and guidelines aimed at improving the management of CAR-T therapy-related infections.

Literatures Citing This Work ​

  1. Infectious complications of CAR T-cell therapy: a clinical update. - Adam G Stewart;Andrea S Henden - Therapeutic advances in infectious disease (2021)
  2. Improving the safety of outpatient parenteral antimicrobial therapy for patients with solid tumors. - Alison Robins;Emma Dishner;Patrick McDaneld;Meagan Rowan;Jalen Bartek;Ying Jiang;Javier Adachi;Natalie J M Dailey Garnes - Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer (2022)
  3. Cytomegalovirus Retinitis and Retinal Detachment following Chimeric Antigen Receptor T Cell Therapy for Relapsed/Refractory Multiple Myeloma. - Cheng Zu;Yufeng Xu;Yiyun Wang;Mingming Zhang;Houli Zhao;Xiaoyun Fang;He Huang;Yongxian Hu - Current oncology (Toronto, Ont.) (2022)
  4. Effects of B-Cell Lymphoma on the Immune System and Immune Recovery after Treatment: The Paradigm of Targeted Therapy. - Salvatrice Mancuso;Marta Mattana;Melania Carlisi;Marco Santoro;Sergio Siragusa - International journal of molecular sciences (2022)
  5. Humoral Responses to Repetitive Doses of COVID-19 mRNA Vaccines in Patients with CAR-T-Cell Therapy. - Simona Gössi;Ulrike Bacher;Claudia Haslebacher;Michael Nagler;Franziska Suter;Cornelia Staehelin;Urban Novak;Thomas Pabst - Cancers (2022)
  6. Serologic response and safety of COVID-19 vaccination in HSCT or CAR T-cell recipients: a systematic review and meta-analysis. - Chenghao Ge;Kelei Du;Mingjie Luo;Kaini Shen;Yangzhong Zhou;Kaiyuan Guo;Yang Liu;Chen Yin;Yi Li;Guanqiao Li;Xiaoyuan Chen - Experimental hematology & oncology (2022)
  7. Current updates on generations, approvals, and clinical trials of CAR T-cell therapy. - Tadesse Asmamaw Dejenie;Markeshaw Tiruneh G/Medhin;Gashaw Dessie Terefe;Fitalew Tadele Admasu;Wondwossen Wale Tesega;Endeshaw Chekol Abebe - Human vaccines & immunotherapeutics (2022)
  8. Current progress in CAR-T cell therapy for tumor treatment. - Lei Chen;Ting Xie;Bing Wei;Da-Lin Di - Oncology letters (2022)
  9. Olecranon bursitis caused by Scedosporium apiospermum in a patient treated with CAR-T cells. - Willem J J Falkenburg;Marit Jalink;Marie José Kersten;Jochem B Buil;Karin van Dijk - Medical mycology case reports (2022)
  10. Gastric Cancer and the Immune System: The Key to Improving Outcomes? - Sara H Keshavjee;Ryan H Moy;Steven L Reiner;Sandra W Ryeom;Sam S Yoon - Cancers (2022)

... (34 more literatures)

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