The Community Focus Channel is supported with funding from Johnson & Johnson (Gold).
VJHemOnc is an independent medical education platform. Supporters, including channel supporters, have no influence over the production of content. The levels of sponsorship listed are reflective of the amount of funding given to support the channel.
EBMT 2026 | Should antibiotics be used in febrile patients following CAR-T infusion?
Eleftheria Kampouri, MD, University of Lausanne, Lausanne, Switzerland, discusses the management of patients who develop a fever following CAR T-cell infusion. Dr Kampouri suggests discontinuing or de-escalating antibiotics in stable patients whose fever subsides and in whom no pathogen is identified, to minimize the risk of antibiotic resistance and microbiome disruption. This interview took place at the 52nd Annual Meeting of the EBMT in Madrid, Spain.
These works are owned by Magdalen Medical Publishing (MMP) and are protected by copyright laws and treaties around the world. All rights are reserved.
Transcript
So basically fever is very frequent in the first weeks after CAR T-cell infusion and this can be due to infection, also very frequently due to cytokine release syndrome or both, there is no way of telling. This fever occurs during the period of severe neutropenia. So the cornerstone of the management of febrile neutropenia is antibiotics, broad-spectrum antibiotics...
So basically fever is very frequent in the first weeks after CAR T-cell infusion and this can be due to infection, also very frequently due to cytokine release syndrome or both, there is no way of telling. This fever occurs during the period of severe neutropenia. So the cornerstone of the management of febrile neutropenia is antibiotics, broad-spectrum antibiotics. So I think that we cannot really take the risk of not covering a potentially life-threatening infection during the period where the patients are the most fragile. Of course, this comes at a cost. We are all aware that we might be over-treating CRS even when there is no infection. And this can have a toll both on antibiotic resistance, on the microbiome, which we know is kind of important even for hematological outcomes. But on the other hand, we don’t have a lot of other options. There are some very interesting data on how to risk stratify in order to distinguish patients with CRS versus infection, but again, this may not be available or may not be very clinically applicable at this time. So I think personally that our best option would be to kind of discontinue and de-escalate antibiotics in stable patients who have no longer a fever, for whom we have not identified a pathogen or a clinical focus of infection. I think our best bet would be to just treat for a short period of time.
This transcript is AI-generated. While we strive for accuracy, please verify this copy with the video.
Read more...
Disclosures
Disclosures: Advisory board: MSD; Honoraria: MSD, Takeda; Grants: Swiss National Science Foundation (P500PM_202961), Santos Suarez Foundation Switzerland, SICPA Foundation Switzerland, Dharam Ablashi Research Fund, Pilot Grant by HHV-6 Foundation.
