大 B 细胞淋巴瘤 CD19 CAR-T 细胞治疗后的感染：来自 CIBMTR 的真实世界分析

Infection is increasingly recognized as a significant cause of morbidity and mortality in patients with relapsed/refractory (R/R) large B-cell lymphoma (LBCL) receiving CD19 chimeric antigen receptor (CAR) T-cell therapy. The current study analyzed the natural history, risk factors, and outcomes of infection in 3350 patients with R/R LBCL receiving commercial CD19 CAR T-cell therapy (n = 2804 axicabtagene ciloleucel [axi-cel], n = 546 tisagenlecleucel) from December 2017 to June 2022. Infection developed in 834 patients (24. 9%) within 100 days after infusion, resulting in an infection density of 0. 43 per 100 patient days and a 100-day cumulative incidence of 22%. Bacterial, viral, and fungal infections were recorded in 527 (15. 7%), 374 (11.

2%), and 108 patients (3. 2%), respectively, with corresponding infection densities of 0. 23, 0. 15, and 0. 04 per 100 patient days. After a 24-month median follow-up, 1482 patients (44%) had died, with infection as the primary cause in 173 cases (12%). The 100-day infection-related mortality (IRM) was 1. 6% (95% confidence interval, 1. 2-2. 0).

Patients with a Karnofsky performance score of 80, infection history before CAR T-cell therapy, axi-cel therapy, severe cytokine release syndrome (grade 3), and severe immune effector cell-associated neurotoxicity syndrome (grade 3) had increased infection risk. Infections within 100 days were an independent risk factor for inferior overall survival beyond day 100 after CD19 CAR T-cell therapy.

In conclusion, study results show a significant incidence of infection and IRM in patients with R/R LBCL treated with CD19 CAR T-cell therapy.

Furthermore, results identify patients at a heightened risk of infection, offering insights to guide potential interventions aimed at mitigating infection and improving patient outcomes after CAR T-cell therapy.