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Question 1 of 2
Bacterial infections are common in the period after CAR T-cell therapy. What percentage of infections are reported as bacterial among patient cohorts in most studies?
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Infection is a common adverse event during chimeric antigen receptor (CAR) T-cell and bispecific antibody therapies, with the extent, type, and timing of risk dictated by several factors.1 Baseline infection may vary depending on the type of myeloma and treatment regimens used, and reporting of infections during therapy is often insufficiently detailed to describe the epidemiology. Furthermore, there is a lack of standardization between microbiologically versus clinically-defined infections and prophylaxis is often varied and poorly described. Together, these issues present challenges in understanding the incidences associated with CAR T-cell and bispecific antibody therapies.1
To bridge this knowledge gap, Hammond gave a presentation at the 4th Immune Effector Cell Therapies in Multiple Myeloma (MM) Workshop on infection incidence associated with CAR T-cell and bispecific antibody therapy. We summarize the key points in the article below.
CAR T-cell therapy is commonly associated with a risk of infection and especially infections that present after an extended period post infusion:
Several studies have highlighted potential risk factors associated with an increased infection risk post infusion. These include cases of hypogammaglobulinemia and the number of previous lines of therapy:
Figure 1. Changes in IgG levels in a patient cohort during the first 12 months after CAR T-cell therapy*
CAR, chimeric antigen receptor; IgG, immunoglobulin G.
*Adapted from Hammond1 and Kambhampati, et al.4
Cytomegalovirus (CMV) reactivation events have been reported among patients treated with CAR T-cell therapy. Reports have included:
It remains unclear whether these rates are higher than those normally associated with patients diagnosed with relapsed/refractory MM as both hematopoietic stem cell transplantation and daratumumab treatment have also been associated with CMV reactivation.
Early studies have suggested that infection after bispecific antibody treatment may be even more common than infection associated with CAR T-cell therapy and that infection rates vary depending on the antibody target.
Figure 2. Rates of neutropenia and infection in patients treated with BCMA and non-BCMA antibody therapy*
BCMA, B-cell maturation antigen.
*Adapted from Hammond.1
Opportunistic infections have also been reported across several trials. Pneumocystis was reported in 3.6% of patients enrolled in a phase I/II trial of teclistamab. Fatal adenovirus pneumonia was also reported in this trial, along with multiple cases in other trials and studies, including a phase I trial of talquetamab. Other opportunistic infections reported included:
While CAR T-cell and bispecific antibody therapies offer important treatment opportunities for patients with MM, late and opportunistic infections after treatment present significant challenges to achieving optimal patient outcomes. Bacterial and viral infections are common, and hypogammaglobulinemia leading to a risk of viral reactivation and severe opportunistic infections is widespread and persistent. A focus on appropriate prophylactic and management techniques is essential for improving patient outcomes.
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