Faculty Collaboration Database

Infection after CD19 chimeric antigen receptor T-cell therapy for large B-cell lymphoma: real-world analysis from CIBMTR. Blood Adv 2025 Nov 11;9(21):5460-5472

Date

05/28/2025

Pubmed ID

40435511

Pubmed Central ID

PMC12607006

DOI

10.1182/bloodadvances.2025016141

Scopus ID

2-s2.0-105011883246 (requires institutional sign-in at Scopus site)   1 Citation

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 patients with R/R LBCL receiving commercial CD19 CAR T-cell therapy (n = 2804 axicabtagene ciloleucel [axi-cel], n = 546 tisagenlecleucel) from December 2017 to June 2022. Infection developed in 834 patients (24.9%) within 100 days after 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 patients (3.2%), 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 patients (44%) 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 a Karnofsky performance score of ≤80, infection history before CAR T-cell therapy, axi-cel 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 therapy. Furthermore, results identify patients at a heightened risk of infection, offering insights to guide potential interventions aimed at mitigating infection and improving patient outcomes after CAR T-cell therapy.

Author List

Wudhikarn K, Herr MM, Chen M, Martens MJ, Baird JH, Gowda L, Rangarajan HG, Abid MB, Kharfan-Dabaja MA, Williams KM, Ganguly S, Young JH, Sharma A, Fatobene G, Jain T, Kanakry CG, Modi D, Grover NS, Salem B, Batista MV, Vergidis P, Yin DE, Beitinjaneh AM, Kelkar AH, Nishihori T, Holter Chakrabarty J, Gergis U, Smith M, El Boghdadly Z, Dandoy CE, Murthy HS, Huppler AR, Perales MA, Chemaly RF, Hill JA, Riches M, Auletta JJ

Authors

Anna Huppler MD Associate Professor in the Pediatrics department at Medical College of Wisconsin
Michael Martens PhD Assistant Professor in the Data Science Institute department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adolescent
Adult
Aged
Aged, 80 and over
Antigens, CD19
Biological Products
Female
Humans
Immunotherapy, Adoptive
Lymphoma, Large B-Cell, Diffuse
Male
Middle Aged
Receptors, Antigen, T-Cell
Risk Factors
Young Adult