Best Practice Considerations by The American Society of Transplant and Cellular Therapy: Infection Prevention and Management After Chimeric Antigen Receptor T Cell Therapy for Hematological Malignancies

Shahid, Zainab; Jain, Tania; Dioverti, Veronica; Pennisi, Martina; Mikkilineni, Lekha; Thiruvengadam, Swetha Kambhampati; Shah, Nirali N; Dadwal, Sanjeet; Papanicolaou, Genovefa; Hamadani, Mehdi; Carpenter, Paul A.; Alfaro, Gabriela Maron; Seo, Susan K.; Hill, Joshua A.

doi:10.1016/j.jtct.2024.07.018

Transplantation and Cellular Therapy

2024

DOI: 10.1016/j.jtct.2024.07.018

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Best Practice Considerations by The American Society of Transplant and Cellular Therapy: Infection Prevention and Management After Chimeric Antigen Receptor T Cell Therapy for Hematological Malignancies

Zainab Shahid,

Tania Jain,

Veronica Dioverti

et al.

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Striking the right balance: Navigating antimicrobial stewardship and antibiotic prescribing after CAR‐T‐cell therapy

Reynolds,

Smibert,

Kampouri

2024

Transplant Infectious Dis

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Therapy 28 best-practice statement highlights several areas of research needed to improve supportive care of CAR-T-cell therapy recipients, including microbiome endpoints for antimicrobial stewardship interventions, approaches to infection risk stratification, improved understanding of immune reconstitution, and long-term infection risk. Keri et al. provide an example of the clinical data that drives these recommendations. Their study emphasizes the need for individualized antimicrobial strategies, the importance of rapid diagnostics to reduce unnecessary antibiotic exposure, and highlights CDI as an important complication in this context. Future research should aim to integrate microbiome analysis and risk stratification tools into clinical practice to optimize outcomes for CAR-T-cell therapy recipients.

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Striking the right balance: Navigating antimicrobial stewardship and antibiotic prescribing after CAR‐T‐cell therapy

Reynolds,

Smibert,

Kampouri

2024

Transplant Infectious Dis

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Survivorship in Chimeric Antigen Receptor T-Cell Therapy Recipients: Infections, Secondary Malignancies, and Non-Relapse Mortality

Tix,

Subklewe,

von Bergwelt-Baildon

et al. 2024

Oncol Res Treat

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Background: Chimeric antigen receptor (CAR) T cell therapy has significantly advanced the treatment of hematologic malignancies, offering curative potential for patients with relapsed or refractory disease. However, the long-term survivorship of these patients is marked by unique challenges, particularly immune deficits and infectious complications, second primary malignancies (SPMs), and non-relapse mortality (NRM). Understanding and addressing these risks is paramount to improving patient outcomes and quality of life. Summary: This review explores the incidence and risk factors for non-relapse mortality and long-term complications following CAR T cell therapy. Infections are the leading cause of NRM, accounting for over 50% of cases, driven by neutropenia, hypogammaglobulinemia, and impaired cellular immunity. SPMs, including secondary myeloid and T-cell malignancies, are increasingly recognized, prompting the FDA to issue a black box warning, although their direct link to CAR T cells remains disputed. While CAR T cell-specific toxicities like CRS and ICANS contribute to morbidity, they represent only a minority of NRM cases. The management of these complications is critical as CAR T cell therapy is being evaluated for broader use, including in earlier treatment lines and for non-malignant conditions like autoimmune diseases. Key Messages: CAR T cell therapy has revolutionized cancer treatment, but survivorship is complicated by infections, SPMs, and ultimately endangered by NRM. Prophylactic strategies, close monitoring, and toxicity management strategies are key to improving long-term outcomes.

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Best Practice Considerations by The American Society of Transplant and Cellular Therapy: Infection Prevention and Management After Chimeric Antigen Receptor T Cell Therapy for Hematological Malignancies

Cited by 2 publications

References 100 publications

Striking the right balance: Navigating antimicrobial stewardship and antibiotic prescribing after CAR‐T‐cell therapy

Striking the right balance: Navigating antimicrobial stewardship and antibiotic prescribing after CAR‐T‐cell therapy

Survivorship in Chimeric Antigen Receptor T-Cell Therapy Recipients: Infections, Secondary Malignancies, and Non-Relapse Mortality

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