Effect of CAR T-cell therapy on CMV incidence and outcomes
Lin RY, Anderson AD, Natori Y, et al. Incidence and Outcomes of Cytomegalovirus Reactivation After Chimeric Antigen Receptor T Cell Therapy. Blood Advances. 2024; (doi: 10.1182/bloodadvances.2024012922).
Considering its association with greater overall mortality, researchers recommend preventive strategies to protect high-risk patients against cytomegalovirus (CMV) reactivation following chimeric antigen receptor (CAR) T-cell therapy. To better understand the scope of this complication, which often affects allogeneic hematopoietic cell transplantation recipients, investigators retrospectively studied a sample population of adult CMV-seropositive patients who underwent CAR T-cell treatment between February 2018 and February 2023. Among 95 participants, 33% exhibited signs of CMV reactivation and 11% had clinically significant CMV infection. A median 19 days elapsed between CAR-T cell infusion and CMV reactivation. Patients with grade 3-4 cytokine release syndrome and those who received corticosteroids or ≥2 immunosuppressants had a significantly higher cumulative incidence of CMV. Factors associated with clinically significant CMV include receipt of corticosteroids, tocilizumab, anakinra and >- 2 immunosuppressants which correlated to a 2-fold increase in CMV reactivation in multivariate analysis, and those with CMV reactivation had significantly higher mortality at 1 year.