EBMT 2025 | The risk of infection after CAR T-cell therapy

Well, we do know that infection risk after CAR T-cell therapy is very high. We also know that infections are the number one cause of non-relapse mortality. So it’s very important to be able to treat them and prevent them right. Yet there are so many unknowns when it comes to infection prevention. There is important heterogeneity between different centers. Not two centers are doing the same thing. I would say as far as epidemiology goes, in the first month, so the main early infections are going to be bacterial because this is mainly due to neutropenia. We’ll see febrile neutropenia. Most of the patients will be on broad-spectrum antibiotics. The big difficulty there is that these patients may have fever due to other causes, due to cytokine release syndrome, or effector cell-associated neurotoxicity syndrome. We have no way of telling them apart. So most of the patients will be on antibiotics, broad-spectrum antibiotics at that point. 

We do have some viral reactivations. And, you know, because valaciclovir is so broadly used, we do not see HSV or VZV, but CMV reactivation can be frequent. However, we do not see a lot of end-organ disease, so that’s pretty reassuring. And way, way less than in the allogeneic transplant recipients. 

And then in the long run, I would say mostly respiratory viruses for which vaccination remains the key preventive strategies. And we do see a lot of pulmonary infections due to encapsulated bacteria because, you know, humoral immunodeficiency is still a big thing in the long run after CAR T-cell therapy.

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