接受标准治疗 CD19 或 BCMA 靶向 CAR-T 细胞治疗的血液系统恶性肿瘤患者中巨细胞病毒感染高发生率

Infections are a common source of nonrelapse morbidity and mortality (NRM) following chimeric antigen receptor (CAR)-T cell therapy. However, data regarding cytomegalovirus (CMV) are limited.

We aimed to report the incidence and risk factors of CMV infection (CMVI) after CAR-T cell therapy and describe their clinical outcomes. STUDY DESIGN: We conducted a retrospective chart review study among patients who received commercial CAR-T therapy between May 21, 2021 and July 31, 2023 with undetectable CMV by quantitative polymerase chain reaction (PCR) prior to lymphodepletion (LD) and underwent at least 1 CMV PCR test post-CAR-T. The primary endpoint was the cumulative incidence of CMVI at day 30 post-CAR-T.

In total, 239 patients were included. After CAR-T, 50 patients (21%) had a positive CMV PCR at a median of 23 days (range: 3-602) postinfusion. The cumulative incidence of CMVI was 16% (95% CI = 12%-21%) at day 30, and 20% (95% confidence interval [CI] = 9%-18%) at day 100. By fitting a multivariable Cox proportional hazards model, patients with a positive CMV IgG at pre-LD or who received corticosteroid post CAR-T were at higher risk of developing a CMVI: adjusted hazard ratio (aHR) = 8.3, 95% CI = 2.6-26.9, P < .001; and aHR = 2.2, 95% CI = 1.2-4.2, P = .013, respectively.

CMVI is an underrecognized complication following CAR-T cell therapy. Patients with positive CMV IgG prior to LD, older age at LD, or who receive corticosteroids post-CAR-T are at higher risk for CMVI.