Chimeric antigen receptor-T-cell therapies going viral: latent and incidental viral infections

Kampouri, E; Reynolds, G; Teh, BW; Hill, JA

Author(s): Kampouri, E; Reynolds, G; Teh, BW; Hill, JA;
Details: Publication Year 2024-12-01,Volume 37,Issue #6,Page 526-535
Journal Title: Current Opinion in Infectious Diseases
Publication Type: Review
Abstract: PURPOSE OF REVIEW: Infections are the leading cause of non-relapse mortality following chimeric antigen receptor (CAR)-T-cell therapy, with viral infections being frequent both in the early and late phases post-infusion. We review the epidemiology of viral infections and discuss critical approaches to prevention and management strategies in this setting. RECENT FINDINGS: Herpesviruses dominate the early period. herpes simplex virus and varicella zoster virus infections are rare due to widespread antiviral prophylaxis, but cytomegalovirus (CMV) reactivation is increasingly observed, particularly in high-risk groups including B cell maturation antigen (BCMA)-CAR-T-cell therapy recipients and patients receiving corticosteroids. While CMV end-organ disease is rare, CMV is associated with increased mortality, emphasizing the need to evaluate the broader impact of CMV on long-term hematological, infection, and survival outcomes. Human herpesvirus-6 (HHV-6) has also emerged as a concern, with its diagnosis complicated by overlapping symptoms with neurotoxicity, underscoring the importance of considering viral encephalitis in differential diagnoses. Respiratory viruses are the most common late infections with a higher incidence after BCMA CAR-T-cell therapy. Vaccination remains a critical preventive measure against respiratory viruses but may be less immunogenic following CAR-T-cell therapy. The optimal timing, type of vaccine, and dosing schedule require further investigation. SUMMARY: A better understanding of viral epidemiology and preventive trials are needed to improve infection prevention practices and outcomes following CAR-T-cell therapies.
Publisher: Wolters Kluwer
Keywords: Humans; *Receptors, Chimeric Antigen/immunology; *Immunotherapy, Adoptive/methods; *Virus Diseases/prevention & control/immunology/therapy
Department(s): Infectious Diseases
Publisher's Version: https://doi.org/10.1097/qco.0000000000001066
Terms of Use/Rights Notice: Refer to copyright notice on published article.

Creation Date: 2024-11-28 06:25:34

Last Modified: 2024-11-28 06:29:09