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Infection Risk Following CAR T Therapy for Multiple Myeloma
Posted: Oct 08, 2021
Infection Risk Following CAR T Therapy for Multiple Myeloma image

A limited number of multiple myeloma patients have received CAR T therapy and we are learning more each day about the new treatment.

UCSF researchers performed an analysis of 55 myeloma patients who had received prior CAR T to identify infection risk after the treatment is given. When studying patients up to one year post CAR T therapy, they found that there were infections in 53% of patients but most infections (92%) were mild or moderate and were primarily based in the lower/upper respiratory tract system (68%). 

Were the patients prone to develop infections because of their prior immune system status? The researchers learned that 35% of patients had severe hypogammaglobulinemia (problems with the immune system in making antibodies to fight infection the infections) even before they received the preparatory lymphodepleting chemotherapy for their CAR T infusion, and another 18% had severe lymphopenia (low counts of a type of white blood cells called lymphocytes).  

Most of the patients had received protective antibacterial treatment after their CAR T infusion (for an average of 22.5 days), shingles prevention, antiviral medication (average of 182 days) and antifungal medication (16.5 days).

There were 58% of patients who had received at least one dose of IVIG within 12 months following CAR T therapy. 

More severe neutropenia and lymphopenia was found in the first month post CAR T and improved over time.

With a median follow-up of 6 months, there were a total of 47 infection events in 29 of the patients (some patients had more than one infection). Of these infections, 40% were bacterial, 53% were viral and 6% were fungal infections. 

Half of the infections (53%) occurred in the first 100 days post CAR T infusion.

Although there were many risk factors for this group of heavily pre-treated patients, relatively few life-threatening or severe infections occurred. At one year after their CAR T infusion, 76% of patients had low immunoglobulins (infection fighting cells).

Expert Suggestions

Though the rates of severe infections were low, the UCSF research shows that infections can occur post CAR T therapy even when patients have been given preventive care. Based on these results, the study authors suggest the following: 

  1. Patients take antibacterial treatment for at least one month post CAR T
  2. Patients have shingles (VZV) prophylaxis for 6 months
  3. Patients have pneumonia prevention medication for 3 months
  4. The anti-fungal fluconazole should be tailored to a patient's risk for prolonged neutropenia
  5. G-CSF can be considered in the first 3 months following CAR T, but that could also increase Cytokine Release Syndrome (CRS), so the risks and benefits should be considered in the early period after CAR T cell infusion. 
  6. Early use of the bone marrow stimulant Nuelasta (pegfilgastrim) as a possibility
  7. Consideration of mold prevention if they have recurrent neutropenia



The author Jennifer Ahlstrom

about the author
Jennifer Ahlstrom

Myeloma survivor, patient advocate, wife, mom of 6. Believer that patients can help accelerate a cure by weighing in and participating in clinical research. Founder of HealthTree Foundation (formerly Myeloma Crowd). 

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