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Infection after CD19 chimeric antigen receptor T cell therapy for large B cell lymphoma: Real-world analysis from CIBMTR.

Infection after CD19 chimeric antigen receptor T cell therapy for large B cell lymphoma: Real-world analysis from CIBMTR. Blood advances Wudhikarn, K., Herr, M. M., Chen, M., Martens, M. J., Baird, J. H., Gowda, L., Rangarajan, H. G., Abid, M. B., Kharfan-Dabaja, M. A., Williams, K. M., Ganguly, S., Young, J. H., Sharma, A., Fatobene, G., Jain, T., Kanakry, C. G., Modi, D., Grover, N. S., Salem, B., Batista, M. V., Vergidis, P., Yin, D. E., Beitinjaneh, A. M., Kelkar, A. H., Nishihori, T., Holter-Chakrabarty, J., Gergis, U., Smith, M., El Boghdadly, Z., Dandoy, C. E., Murthy, H. S., Huppler, A. R., Perales, M. A., Chemaly, R. F., Hill, J. A., Riches, M., Auletta, J. J. 2025

Abstract

Infection is increasingly recognized as a significant cause of morbidity and mortality in patients with relapsed/refractory (R/R) large B-cell lymphoma (LBCL) receiving CD19 chimeric antigen receptor (CAR) T-cell therapy. The current study analyzed the natural history, risk factors, and outcomes of infection in 3350 R/R LBCL patients receiving commercial CD19 CAR T-cell (n=2804 axicabtagene ciloleucel, n=546 tisagenlecleucel) from December 2017 to June 2022. Infection developed in 834 (24.9%) patients within 100 days post-infusion, resulting in an infection density of 0.43 per 100 patient-days and a 100-day cumulative incidence of 22%. Bacterial, viral, and fungal infections were recorded in 527 (15.7%), 374 (11.2%), and 108 (3.2%) patients, respectively, with corresponding infection densities of 0.23, 0.15, and 0.04 per 100 patient-days. After a 24-month median follow-up, 1482 (44%) patients had died, with infection as the primary cause in 173 cases (12%). The 100-day infection-related mortality (IRM) was 1.6% (95% confidence interval, 1.2-2.0%). Patients with Karnofsky score =80, infection history pre-CAR-T, axicabtagene ciloleucel therapy, severe cytokine release syndrome (grade =3), and severe immune effector cell-associated neurotoxicity syndrome (grade =3) had increased infection risk. Infections within 100 days were an independent risk factor for inferior overall survival beyond day 100 after CD19 CAR T-cell therapy. In conclusion, study results show a significant incidence of infection and IRM in patients with R/R LBCL treated with CD19 CAR T-cell. Furthermore, results identify patients at heightened risk for infection, offering insights to guide potential interventions aimed at mitigating infection and improving patient outcomes after CAR T-cell therapy.

View details for DOI 10.1182/bloodadvances.2025016141

View details for PubMedID 40435511