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Factors associated with infection events after chimeric antigen receptor T-cell therapy for relapsed or refractory multiple myeloma

  • Author Footnotes
    1 Dian Zhou, Ying Wang and Hai Cheng contributed equally to this study.
    Dian Zhou
    Footnotes
    1 Dian Zhou, Ying Wang and Hai Cheng contributed equally to this study.
    Affiliations
    Blood Diseases Institute, Xuzhou Medical University, Xuzhou, Jiangsu, China

    Department of Hematology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China

    Jiangsu Key Laboratory of Bone Marrow Stem Cells, Xuzhou, Jiangsu, China
    Search for articles by this author
  • Author Footnotes
    1 Dian Zhou, Ying Wang and Hai Cheng contributed equally to this study.
    Ying Wang
    Footnotes
    1 Dian Zhou, Ying Wang and Hai Cheng contributed equally to this study.
    Affiliations
    Blood Diseases Institute, Xuzhou Medical University, Xuzhou, Jiangsu, China

    Department of Hematology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China

    Jiangsu Key Laboratory of Bone Marrow Stem Cells, Xuzhou, Jiangsu, China
    Search for articles by this author
  • Author Footnotes
    1 Dian Zhou, Ying Wang and Hai Cheng contributed equally to this study.
    Hai Cheng
    Footnotes
    1 Dian Zhou, Ying Wang and Hai Cheng contributed equally to this study.
    Affiliations
    Blood Diseases Institute, Xuzhou Medical University, Xuzhou, Jiangsu, China

    Department of Hematology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China

    Jiangsu Key Laboratory of Bone Marrow Stem Cells, Xuzhou, Jiangsu, China
    Search for articles by this author
  • Lili Zhu
    Affiliations
    Department of Pediatrics, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
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  • Wei Chen
    Affiliations
    Blood Diseases Institute, Xuzhou Medical University, Xuzhou, Jiangsu, China

    Department of Hematology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China

    Jiangsu Key Laboratory of Bone Marrow Stem Cells, Xuzhou, Jiangsu, China
    Search for articles by this author
  • Hujun Li
    Affiliations
    Blood Diseases Institute, Xuzhou Medical University, Xuzhou, Jiangsu, China

    Department of Hematology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China

    Jiangsu Key Laboratory of Bone Marrow Stem Cells, Xuzhou, Jiangsu, China
    Search for articles by this author
  • Xiaotian Zhang
    Affiliations
    Blood Diseases Institute, Xuzhou Medical University, Xuzhou, Jiangsu, China

    Department of Hematology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China

    Jiangsu Key Laboratory of Bone Marrow Stem Cells, Xuzhou, Jiangsu, China
    Search for articles by this author
  • Jieyun Xia
    Affiliations
    Blood Diseases Institute, Xuzhou Medical University, Xuzhou, Jiangsu, China

    Department of Hematology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China

    Jiangsu Key Laboratory of Bone Marrow Stem Cells, Xuzhou, Jiangsu, China
    Search for articles by this author
  • Yuekun Qi
    Affiliations
    Blood Diseases Institute, Xuzhou Medical University, Xuzhou, Jiangsu, China

    Department of Hematology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China

    Jiangsu Key Laboratory of Bone Marrow Stem Cells, Xuzhou, Jiangsu, China
    Search for articles by this author
  • Sha Ma
    Affiliations
    Blood Diseases Institute, Xuzhou Medical University, Xuzhou, Jiangsu, China

    Department of Hematology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China

    Jiangsu Key Laboratory of Bone Marrow Stem Cells, Xuzhou, Jiangsu, China
    Search for articles by this author
  • Feng Zhu
    Affiliations
    Blood Diseases Institute, Xuzhou Medical University, Xuzhou, Jiangsu, China

    Department of Hematology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China

    Jiangsu Key Laboratory of Bone Marrow Stem Cells, Xuzhou, Jiangsu, China
    Search for articles by this author
  • Zhiling Yan
    Affiliations
    Blood Diseases Institute, Xuzhou Medical University, Xuzhou, Jiangsu, China

    Department of Hematology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China

    Jiangsu Key Laboratory of Bone Marrow Stem Cells, Xuzhou, Jiangsu, China
    Search for articles by this author
  • Kunming Qi
    Affiliations
    Blood Diseases Institute, Xuzhou Medical University, Xuzhou, Jiangsu, China

    Department of Hematology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China

    Jiangsu Key Laboratory of Bone Marrow Stem Cells, Xuzhou, Jiangsu, China
    Search for articles by this author
  • Wei Sang
    Affiliations
    Blood Diseases Institute, Xuzhou Medical University, Xuzhou, Jiangsu, China

    Department of Hematology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China

    Jiangsu Key Laboratory of Bone Marrow Stem Cells, Xuzhou, Jiangsu, China
    Search for articles by this author
  • Haiying Sun
    Affiliations
    Blood Diseases Institute, Xuzhou Medical University, Xuzhou, Jiangsu, China

    Department of Hematology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China

    Jiangsu Key Laboratory of Bone Marrow Stem Cells, Xuzhou, Jiangsu, China
    Search for articles by this author
  • Depeng Li
    Affiliations
    Blood Diseases Institute, Xuzhou Medical University, Xuzhou, Jiangsu, China

    Department of Hematology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China

    Jiangsu Key Laboratory of Bone Marrow Stem Cells, Xuzhou, Jiangsu, China
    Search for articles by this author
  • Jiang Cao
    Correspondence
    Corresponding author. Department of Hematology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China.
    Affiliations
    Blood Diseases Institute, Xuzhou Medical University, Xuzhou, Jiangsu, China

    Department of Hematology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China

    Jiangsu Key Laboratory of Bone Marrow Stem Cells, Xuzhou, Jiangsu, China
    Search for articles by this author
  • Zhenyu Li
    Correspondence
    Corresponding author. Department of Hematology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China.
    Affiliations
    Blood Diseases Institute, Xuzhou Medical University, Xuzhou, Jiangsu, China

    Department of Hematology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China

    Jiangsu Key Laboratory of Bone Marrow Stem Cells, Xuzhou, Jiangsu, China
    Search for articles by this author
  • Kailin Xu
    Correspondence
    Corresponding author. Department of Hematology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China.
    Affiliations
    Blood Diseases Institute, Xuzhou Medical University, Xuzhou, Jiangsu, China

    Department of Hematology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China

    Jiangsu Key Laboratory of Bone Marrow Stem Cells, Xuzhou, Jiangsu, China
    Search for articles by this author
  • Author Footnotes
    1 Dian Zhou, Ying Wang and Hai Cheng contributed equally to this study.
Published:November 10, 2022DOI:https://doi.org/10.1016/j.jiac.2022.10.012

      Abstract

      Objectives

      Chimeric antigen receptor (CAR) T-cell therapy is a new and effective method in relapsed or refractory (R/R) multiple myeloma (MM). This study was aimed to explore the risk factors of infection events.

      Methods

      We retrospectively analyzed 68 patients with R/R MM who received CAR T-cell therapy at the Affiliated Hospital of Xuzhou Medical University from June 2017 to June 2021.35 patients received anti-CD19 combined with anti-BCMA CAR T-cell therapy and 33 patients received anti-BCMA CAR T-cell therapy alone.

      Results

      Infection events in patients who received ≥4 prior lines of treatment or with grade 3–5 cytokines released syndrome (CRS) mainly occurred within 4 months after CAR T-cell infusion(CTI). The duration of infection-free survival was positively correlated with progression-free survival of patients with R/R MM (R2 = 0.962, p < 0.001) and the first infection event was closely accompanied by the disease relapse or progression. Treatment lines (p = 0.05), duration of ANC<500 cells/mm3 after CTI (p = 0.036), CRS grade (p = 0.007) and treatment response (p < 0.001) were the independent risk factors associated with infection for a multivariable model. The infection incidence was higher in patients with dual CAR T-cell therapy than with mono CAR T-cell therapy18 months after CTI although no statistic differences were observed within 18 months.

      Conclusions

      Infections after CTI were closely associated with more lines of prior treatment, longer duration of ANC<500 cells/mm3, higher grade CRS and poor treatment response. Infections tended to occur in the early stage after CTI in patients with more lines of prior treatment and higher grade CRS.

      Keywords

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