Management of Infections and Vaccination in CAR-T Cell Therapy

Abstract

Candidates for CAR-T cell therapy are at increased risk of infections due to the high degree of pre-existing immunosuppression. In addittion, the currently approved CAR-T cell therapy products have severe toxicities, including cytokine release syndrome (CRS) and immune-effector cell associated neurological syndrome (ICANS), which treatments may result in deep and long-term immunological deficits, as the CAR-T cells can persist for years. Approximately 18% to 34% of patients develop infections within the first 2 months after CAR-T therapy despite antimicrobial prophylaxis. The goals of the present manuscript are: 1) Describe the procedures necessary for the clinical and epidemiological evaluation of the chimeric antigen receptor T-cell therapy (CAR-T cell therapy) candidate, classify the infectious risk, define the criteria for the implementation of prophylactic, empirical and preemptive antimicrobial strategies and guide laboratory and clinical monitoring of the infectious events; 2) Define the indications and contraindications of inactivated and attenuated vaccines and propose a vaccination schedule before and after CAR-T therapy.