Preventing and Monitoring Infections With Immune Therapies | Joshua Richter, MD | IMS 2023

Hi, my name is Joshua Richter. I'm an associate professor of medicine at the Tisch Cancer Institute, Icon School of Medicine at Mount Sinai. And I'm here at IMS 2023, and I'm presenting on prophylaxis and management of infectious complications of immune therapy. So in the last few years, we've had a number of FDA approvals, now five different approvals for T cell redirection therapy spanning CAR-Ts and bispecifics. We're seeing unprecedented response rates with these types of treatments. However, we're seeing multimodalities of immune suppression in brand new ways and seeing a number of patients have infectious complications. So when you give these therapies, you have so many different ways in which the immune system gets suppressed. You have lowered blood counts in cytopenias, you have hypogammaglobulinemia, but the other is the notion of T cell redirection. Once you have T cells that are kind of preordained to take care of bacteria, viruses, and fungus, and you say, no, no, no, come here, I need you to fight cancer, no one's minding the shop. So we're starting to see that we're having lots of infections, and we're starting to come up with better ways of managing this. Primary prophylaxis with IVIG to prevent complications of hypogammaglobulinemia. Anti-infected prophylaxis is changing its way as well. So as part of our therapies, we used to give pneumocystis prevention, when the old days of giving dexamethasone four days on, four days off. Then we saw a drop in PJP cases, where we weren't given as much steroid. Now with T cell redirection, we're seeing a rise again, and we prophylax all patients undergoing CAR T's or bispecific antibodies with PJP prophylaxis. And then the other thing we're starting to tune into is the notion of viral reactivation. Viruses such as EBV and CMV, we need to monitor for because we found that when you have prolonged T cell suppression, you can actually get a recurrence of these viruses, which makes management a little more complicated. So overall, we're getting better and better at managing this, and prophylaxis is really the key to prevent major complications while patients achieve very deep and durable remissions with T cell redirection therapy.