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Publications

Journal Article Review Ppublish 2 citations

PubMed: 39361275 DOI: 10.1097/QCO.0000000000001066

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

Curr Opin Infect Dis 37(6):526-535

Authors: Eleftheria Kampouri, Gemma Reynolds, Benjamin W Teh, Joshua A Hill

Affiliations

  • Infectious Diseases Service, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
  • Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne.
  • Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville.
  • National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.
  • Vaccine and Infectious Disease Division.
  • Clinical Research Division, Fred Hutchinson Cancer Center.
  • Department of Medicine, University of Washington, Seattle, Washington, USA.

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.

MeSH

Cells, Mortality, Epidemiology, Vaccines, Herpesvirus 6, Human, Receptors, Antigen, Viruses, Receptors, Chimeric Antigen, Diagnosis, Therapeutics, T-Lymphocytes, Infections, Virus Diseases, Receptors, Antigen, T-Cell

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