Infectious Diseases Department, Bellvitge University Hospital, IDIBIELL, University of Barcelona, Barcelona, Spain; Institut Català d'Oncologia, Barcelona, Spain; Spanish Network for Research in Infectious Diseases, Instituto de Salud Carlos III, Madrid, Spain.
Unit of Infectious Diseases, Department of Medical and Surgical Sciences, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy.
Lancet Haematol. 2021 Mar;8(3):e216-e228. doi: 10.1016/S2352-3026(20)30376-8. Epub 2021 Jan 15.
Therapy with genetically engineered chimeric antigen receptor (CAR) T cells targeting the CD19 antigen is promising for a number of refractory or relapsed B-cell malignancies. Information on the infectious complications of this immunotherapeutic strategy is scarce and difficult to interpret, as many factors influence infection incidence and outcomes. CAR T-cell therapy is usually given to patients with haematological cancers who have been heavily pretreated and are severely immunosuppressed. Moreover, the risk of infection is increased by the administration of lymphodepleting chemotherapy before CAR T-cell infusion, and by the development of complications such as cytokine release syndrome or immune effector cell-associated neurotoxicity syndrome, which are managed with anti-interleukin-6 antibodies, or corticosteroids, or both. On-target, off-tumour toxicities, such as B-cell aplasia, hypogammaglobulinaemia, and persistent or biphasic cytopenia, are common. In this Review, we evaluate the reported infectious complications of CAR T-cell therapy and associated risk factors and offer perspectives on its infection risk.
嵌合抗原受体 (CAR) T 细胞靶向 CD19 抗原的基因工程治疗在多种难治性或复发性 B 细胞恶性肿瘤中具有广阔的前景。由于许多因素会影响感染的发生率和结果，因此关于这种免疫治疗策略的感染并发症的信息很少且难以解释。CAR T 细胞治疗通常用于接受过大量预处理且严重免疫抑制的血液系统癌症患者。此外，在输注 CAR T 细胞之前使用淋巴细胞耗竭化疗以及发生细胞因子释放综合征或免疫效应细胞相关神经毒性综合征等并发症会增加感染风险，这些并发症可以使用抗白细胞介素 6 抗体、皮质类固醇或两者联合治疗。针对肿瘤的、非肿瘤毒性，如 B 细胞发育不全、低丙种球蛋白血症和持续或双相血细胞减少症，很常见。在这篇综述中，我们评估了报道的 CAR T 细胞治疗的感染并发症及其相关危险因素，并对其感染风险提出了看法。
