Infectious complications in patients with relapsed refractory multiple myeloma after BCMA CAR T-cell therapy

B-cell maturation antigen-targeted chimeric antigen receptor T-cell therapy (BCMA CAR-T) is an effective treatment of relapsed refractory multiple myeloma (MM). However, the pattern of infectious complications is not well elucidated. We performed a single-center retrospective analysis of infection o...

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Bibliographic Details
Published in:Blood advances 2022-04, Vol.6 (7), p.2045-2054
Main Authors: Kambhampati, Swetha, Sheng, Ying, Huang, Chiung-Yu, Bylsma, Sophia, Lo, Mimi, Kennedy, Vanessa, Natsuhara, Kelsey, Martin, Thomas, Wolf, Jeffrey, Shah, Nina, Wong, Sandy W.
Format: Article
Language:English
Subjects:
B-Cell Maturation Antigen
Humans
Immunobiology and Immunotherapy
Immunotherapy, Adoptive - adverse effects
Multiple Myeloma - complications
Multiple Myeloma - therapy
Receptors, Chimeric Antigen
Retrospective Studies
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Summary:B-cell maturation antigen-targeted chimeric antigen receptor T-cell therapy (BCMA CAR-T) is an effective treatment of relapsed refractory multiple myeloma (MM). However, the pattern of infectious complications is not well elucidated. We performed a single-center retrospective analysis of infection outcomes up to 1 year after BCMA CAR-T for MM from 2018 to 2020. Fifty-five patients with MM were treated with BCMA CAR-T. Before lymphodepletion (LD), 35% of patients had severe hypogammaglobulinemia and 18% had severe lymphopenia. Most patients (68%) received bridging chemotherapy (BC) before LD. In the first month after CAR-T, 98% patients had grade 3 to 4 neutropenia. At 1 year after infusion, 76% patients had hypogammaglobulinemia. With a median follow-up of 6.0 months (95% confidence interval, 4.7-7.4), there were a total of 47 infection events in 29 (53%) patients: 40% bacterial, 53% viral, and 6% fungal. Most (92%) were mild-moderate and of the lower/upper respiratory tract system (68%). Half of the infections (53%) occurred in the first 100 days after CAR-T infusion. Although no statistically significant risk factors for infection were identified, prior lines of therapy, use of BC, recent infections, and post–CAR-T lymphopenia were identified as possible risk factors that need to be further explored. This is the largest study to date to assess infectious complications after BCMA CAR-T. Despite multiple risk factors for severe immunosuppression in this cohort, relatively few life-threatening or severe infections occurred. Further larger studies are needed to better characterize the risk factors for and occurrence of infections after BCMA CAR-T. •Forty percent bacterial, 53% viral, and 6% fungal infections in 29 of 55 patients with multiple myeloma were observed after BCMA CAR-T.•Most infections after BCMA CAR-T were mild-moderate and involved upper or lower respiratory system. [Display omitted]
ISSN:2473-9529
2473-9537
DOI:10.1182/bloodadvances.2020004079