International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases · 2026
Respiratory Viral Infections Following CAR-T Cell Therapy for Lymphoma and Myeloma: Severity and Immune Correlates.
СтатьяНазвание и аннотация: Перевод в очереди
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Einarsdottir Sigrun, Fei Teng, Sotelo-Alva Maria Isabel, Gomez-Llobell Marina, Escribano-Serrat Silvia, Shi Kayleen, Beyar-Katz Ofrat, Bhamidipati Dedipya, Corona Magdalena, Falchi Lorenzo, Geva Mika, Halloun Jabour, Hultcrantz Malin, Israeli Sapir, Khatib Hazim, Kamboj Mini, Mailankody Sham, Papanicolaou Genovefa, Palomba M Lia, Park Jae H, Raj Sandeep, Scordo Michael, Salles Gilles, Seo Susan K, Shah Gunjan, Shibli Niveen, Arya Swarn, Valtis Yannis, Sanz Jaime, Rejeski Kai, Usmani Saad, Perales Miguel-Angel, Shouval Roni, Shahid Zainab
Аннотация
BACKGROUND: Infectious complications are a major cause of morbidity and non-relapse mortality after CAR-T cell therapy. Respiratory viral infections (RVIs) are frequent, yet their incidence, timing, and immune correlates remain incompletely defined.
METHODS: We retrospectively analyzed laboratory-confirmed RVIs in 563 commercial CAR-T recipients (2018-2024). Episodes were classified as URTI or LRTI and graded by CTCAE v5.0 and additionally characterized by respiratory-support requirement. Immune reconstitution markers were assessed as time-dependent covariates in all patients. Recurrent events were quantified using mean cumulative function estimates, and multivariable Andersen-Gill models assessed risk factors.
RESULTS: Among 563 CAR-T recipients (82% CD19, 18% BCMA; median age 65), 446 laboratory-documented RVI episodes occurred in 259 patients (46%), predominantly beyond day 100. The expected cumulative number of RVIs per patient reached 1.15 by 2 years, with severe (grade ≥3) events reaching 0.25. SARS-CoV-2 (41%) and rhinovirus (27%) predominated; LRTI developed in 18% of episodes, with 10 infection-related deaths. ALC below 0.5 × 10⁹/L was associated with increased risk of recurrent and severe RVI. Lower CD19⁺ B-cell counts and mantle cell lymphoma were independently associated with severe disease.
CONCLUSIONS: Laboratory-documented RVIs are frequent late complications after CAR-T therapy. Impaired immune reconstitution, particularly lymphopenia, is associated with increased risk, with an ALC <0.5 × 10⁹/L emerging as a clinically relevant threshold.
METHODS: We retrospectively analyzed laboratory-confirmed RVIs in 563 commercial CAR-T recipients (2018-2024). Episodes were classified as URTI or LRTI and graded by CTCAE v5.0 and additionally characterized by respiratory-support requirement. Immune reconstitution markers were assessed as time-dependent covariates in all patients. Recurrent events were quantified using mean cumulative function estimates, and multivariable Andersen-Gill models assessed risk factors.
RESULTS: Among 563 CAR-T recipients (82% CD19, 18% BCMA; median age 65), 446 laboratory-documented RVI episodes occurred in 259 patients (46%), predominantly beyond day 100. The expected cumulative number of RVIs per patient reached 1.15 by 2 years, with severe (grade ≥3) events reaching 0.25. SARS-CoV-2 (41%) and rhinovirus (27%) predominated; LRTI developed in 18% of episodes, with 10 infection-related deaths. ALC below 0.5 × 10⁹/L was associated with increased risk of recurrent and severe RVI. Lower CD19⁺ B-cell counts and mantle cell lymphoma were independently associated with severe disease.
CONCLUSIONS: Laboratory-documented RVIs are frequent late complications after CAR-T therapy. Impaired immune reconstitution, particularly lymphopenia, is associated with increased risk, with an ALC <0.5 × 10⁹/L emerging as a clinically relevant threshold.