Infections in children following chimeric antigen receptor T-cell therapy for B-cell acute lymphoblastic leukemia
- Author(s)
- Diamond, Y; Gilsenan, M; Wang, SS; Hanna, D; Conyers, R; Cole, T; Hughes, D; Fleming, J; Meyran, D; Toro, C; Malalasekera, V; Khaw, SL; Haeusler, GM;
- Details
- Publication Year 2023-12,Volume 25,Issue #6,Page e14202
- Journal Title
- Transplant Infectious Disease
- Publication Type
- Review
- Abstract
- BACKGROUND: CD19-directed chimeric antigen receptor T-cell (CAR-T) therapy is transforming care for pediatric patients with relapsed or refractory B-cell acute lymphoblastic leukemia (B-ALL). There are limited pediatric-specific data concerning the infection risks associated with CD19 CAR-T therapy and the adequacy of current antimicrobial prophylaxis guidelines for these patients. METHODS: We describe the antimicrobial prophylaxis used and the types of infectious occurring in the first 100 days following CAR-T therapy for relapsed or refractory B-cell ALL in children and adolescents (≤18 years) at our centre. RESULTS: Twenty-seven patients received their first CAR-T infusion (CTI) during the study period. Almost all patients (96%) had a comprehensive Infectious Diseases review prior to CTI, which informed a personalised prophylaxis or fever/sepsis plan in six (22%). Overall, six (22%) patients had one or more infections during the study period including five (19%, 0.9 per 100 days-at-risk) from days 0-30 and three (n = 20, 15%, 0.6 per 100 days-at-risk) from days 31-100. Bacterial blood stream infections were the most common type of infection encountered during both time periods, and one patient had probable pulmonary aspergillosis. There were no infection-related deaths. CONCLUSION: Our study contributes important information on the spectrum of infections encountered in pediatric patients with B-ALL post CAR-T therapy. Overall, the burden of infectious complications post CAR-T therapy in our cohort is lower than previously reported in the literature. Results suggest that our prophylaxis recommendations are effective in this population.
- Publisher
- Wiley
- Keywords
- Adolescent; Humans; Child; *Receptors, Chimeric Antigen/therapeutic use; Immunotherapy, Adoptive/adverse effects/methods; *Precursor Cell Lymphoblastic Leukemia-Lymphoma/therapy; *Burkitt Lymphoma; *Bacterial Infections/etiology; *Sepsis/drug therapy; Antigens, CD19; *Anti-Infective Agents; Cell- and Tissue-Based Therapy; All; CAR T-cell; immunotherapy; infection; pediatric
- Department(s)
- Infectious Diseases
- Publisher's Version
- https://doi.org/10.1111/tid.14202
- Open Access at Publisher's Site
https://doi.org/10.1111/tid.14202- Terms of Use/Rights Notice
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Creation Date: 2024-01-16 04:29:32
Last Modified: 2024-01-16 04:53:14